Elusive Enemy and a Great Mimicker: Cardiac Sarcoidosis as a Cause of Advanced Heart Failure, a Case Report

Major advances have been made in the treatment of chronic heart failure in recent years, leading to further improvements in patient prognosis. In addition, advanced diagnostic tools, particularly cardiac imaging, allow more accurate characterization of the diseased myocardial tissue, enabling the use of specific treatments. The etiological diagnostic approach is therefore fundamental to optimize patient management but can sometimes be difficult because cardiac imaging findings can be misleading or non-specific. We report a case of rapidly progressive advanced heart failure with clinical and imaging features characteristic of cardiac sarcoidosis. Recognition of this uncommon presentation of heart failure will help clinicians avoid diagnostic delays which are detrimental to the patient’s overall outcome. This report also discusses the specific challenges encountered during the care of a Jehovah's Witness patient requiring advanced heart failure therapies. There is limited data in this setting and the case illustrates specific challenges that are encountered when caring for patients who require advanced heart failure therapies but refuse allogenic blood or blood product transfusions based on religious beliefs.