Cardiac Involvement in Sarcoidosis

Abstract

Cardiac sarcoidosis is a challenging diagnostic entity. Manifestations range from an incidentally discovered, benign condition to fatal cardiomyopathy and arrhythmias. In this review, we discuss the salient clinical features, diagnostic evaluation, treatment, and prognosis of cardiac sarcoidosis. A definitive histologic diagnosis of myocardial sarcoidosis is difficult, and treatment may be necessary in some patients with suspected cardiac involvement even in the absence of histologic confirmation. Optimal strategies to diagnose cardiac involvement have not been clarified. Thallium (201) radionuclide scintigraphy has been most extensively studied; 2-D echocardiography is less sensitive, but may have a complementary role. Additional radionuclide techniques (e.g., gallium (67) or technetium (99) ) may have a role in complex cases. Given the life-threatening nature of cardiac involvement, prompt and aggressive treatment with corticosteroids or immunosuppressive agents, or both, is warranted. Long-term, possibly lifelong, therapy may be required. Serious, recurrent tachyarrhythmias may require implantation of an automatic cardioverter-defibrillator. Recognizing cardiac sarcoidosis and selecting a sensible management strategy remain the major obstacles facing clinicians.

“Sarcoid like” granulomatous pulmonary disease in World Trade Center disaster responders

“…Additionally, serious cardiac dysfunction has also been seen in 5-10% of sarcoidosis patients [Newman et al, 1997]. Overall our findings appear to be consistent with previous studies [Newman et al, 1997;Deng et al, 2002;Crystal, 2004;Smedema et al, 2007]. The incidence rates reported in this study would doubled if the additional 39 cases of sarcoid like granulomatous disease as seen in Figure 1 with incomplete medical records or a final diagnosis of granulomatous disease of unknown etiology were included in our study.…”

“…It has been mentioned in literature that joint involvement is more common than bone and muscle involvement and is seen in about 25-50% of sarcoidosis cases [Crystal, 2004]. Similarly, although clinical evidence of sarcoidosis affecting the heart is uncommon it has been seen in 2-7% of sarcoidosis patients [Deng et al, 2002;Smedema et al, 2007]. Additionally, serious cardiac dysfunction has also been seen in 5-10% of sarcoidosis patients [Newman et al, 1997].…”

Isolated Primary Cardiac Sarcoidosis Presenting as Acute Heart Failure

“…Infiltration and resulting damage of the myocardium are important causes of death (2). Although autopsy studies have established that cardiac involvement is demonstrated in 20% to 50% of cases, cardiac sarcoidosis is symptomatic in only 5% of pa-tients, is an independent predictor of mortality and carries a very poor prognosis (3,4). Although cardiac sarcoidosis entails significant morbidity and mortality due to the development of fatal arrhythmia, atrioventricular conduction disturbances, and refractory congestive heart failure, it is not always easy to diagnose.…”

Non-Invasive Detection of Latent Cardiac Conduction Abnormalities in Patients With Pulmonary Sarcoidosis Application of Signal Averaged Electrocardiogram

“…2 In patients with definite biopsy-proven or clinically-proven cardiac sarcoidosis (CS), corticosteroid therapy should be recommended, even if myocardial biopsy results are negative. 1,3 On the basis of this recommendation, a novel diagnostic approach has been challenged for earlier detection and assessment of cardiac involvement in sarcoidosis patients.…”