Coronary Artery Vasculitis as a Presentation of Cardiac Sarcoidosis

A 40-year-old white man was admitted for excision of a subcutaneous lesion on his torso. He reported a 12-month history of shortness of breath and exertional chest pain, both of which were relieved by rest. The patient was otherwise asymptomatic, and physical examination was noncontributory. He was not taking any medications. Electrocardiographic monitoring during the procedure revealed third-degree heart block with junctional escape and right bundle-branch block at 38 bpm (Figure 1). The patient was hemodynamically stable. An electrophysiology consultation was requested, and the patient was found to have an elevated serum angiotensin-converting enzyme level. Histological examination of the biopsy specimen showed noncaseating granulomata, which confirmed the diagnosis of sarcoidosis.Figure 1. Twelve-lead ECG taken 8 minutes after procedure while the patient was in recovery. This shows third-degree heart block with right bundle-branch block …