Chasing the ACE of hearts.

A case study of a patient presenting with acute pulmonary oedema, dynamic ECG changes and a rise in cardiac biomarkers with no evidence of myocardial infarction. The clinical course followed a dynamic and inflammatory disease process with evidence of sarcoidosis on tissue histology. The patient had an excellent clinical response to corticosteroid therapy with minimal evidence of hyperenhancement (focal fibrosis) on cardiac MRI at 6 months. The case highlights the challenges in making a new diagnosis of sarcoidosis where involvement appears limited to the heart and lymphatic system.