Cardiac Sarcoidosis

Abstract

Sarcoidosis is a systemic disease with a favorable prognosis, high remission rate, and low mortality. Cardiac involvement alters this prognosis. Clinical manifestations most commonly include arrhythmias, conduction abnormalities, and congestive heart failure. Treatment includes immunosuppressant therapy, permanent pacemakers in the setting of conduction abnormalities, and implantable cardioverter-defibrillators in patients at risk for sudden cardiac death. Risk stratification for sudden cardiac death is essential in otherwise asymptomatic patients who have suspected cardiac sarcoidosis.

Cardiac magnetic resonance imaging in heart failure: where the alphabet begins!

“…It can be asymptomatic or present with heart failure, heart block or malignant arrhythmia [91,92]. It is seen in 25% of patients with sarcoidosis and 25-75% of sarcoidosis mortality is due to HF [93][94][95]. CMR can accurately assess the pathological spectrum of sarcoidosis from active inflammation to myocardial fibrosis and subsequent HF.…”

Sarcoidosis and the heart: A review of the literature

“…There are three consecutive histological stages including edema, granulomatous infiltration, and fibrosis leading to postinflammatory scarring (1). Granulomatous inflammation can involve either the myocardium, endocardium, or pericardium (10,16,31,32). The myocardium is the portion of the heart most commonly affected by CS, but the pericardium and endocardium are usually involved as a result of the spread of myocardial inflammation (3,10,32,33).…”

“…Echocardiographic abnormalities are detected in 24-77% of patients with CS (7,(62)(63)(64). These abnormalities include abnormal septal thickening or thinning, dilatation and systolic dysfunction of the LV, regional wall motion abnormalities without involvement of the coronary arteries, a focal intracardiac mass caused by a large granuloma, diastolic dysfunction, valvular regurgitation, papillary muscle dysfunction, pericardial effusions, and macroscopic areas of bright echoes indicating granulomatous inflammation (a speckled or snowstorm pattern) (1,3,7,31,33,42,(65)(66)(67). Further investigation is necessary if a patient has extracardiac sarcoidosis with abnormal 2-D echocardiographic findings and subtle abnormalities in diastolic flow patterns (7).…”

Cardiac sarcoidosis

“…Although they do not cure the disease, their efficiency has been demonstrated [109] with short delay for significant response. Immunosuppressive treatment must be initiated at an early stage, consistently and continuously administered with a maintenance dose over at least 24 months, which for certain patients extends to a lifetime treatment [6,29,[191][192][193][194][195]. Usually, it is possible to obtain a clinical improvement [59,60,97,174], or a stabilization of cardiomyopathy [195].…”