Management of Cardiac Sarcoidosis in 2020

Abstract

Sarcoidosis is an inflammatory granulomatous disease that can affect any organ. Up to one-quarter of patients with systemic sarcoidosis may have evidence of cardiac involvement. The clinical manifestations of cardiac sarcoidosis (CS) include heart block, atrial arrhythmias, ventricular arrhythmias and heart failure. The diagnosis of CS can be challenging given the patchy infiltration of the myocardium but, with the increased availability of advanced cardiac imaging, more cases of CS are being identified. Immunosuppression with corticosteroids remains the standard therapy for the acute inflammatory phase of CS, but there is an evolving role of steroid-sparing agents. In this article, the authors provide an update on the diagnosis of CS, including the role of imaging; review the clinical manifestations of CS, namely heart block, atrial and ventricular arrhythmias and heart failure; discuss updated management strategies, including immunosuppression, electrophysiological and heart failure therapies; and identify the current gaps in knowledge and future directions for cardiac sarcoidosis.

A case of cardiac sarcoidosis with successful heart transplantation after COVID-19 infection

“…CS also has patchy involvement of the heart muscle. It classically presents with atrioventricular conduction disease, arrhythmias, and heart failure [2] . At times, isolated RV sarcoidosis can present with life-threatening arrhythmias that mimic ARVC.…”

“…Sarcoidosis is characterized by the presence of non-necrotizing granulomas that involve multiple organs, most commonly the lungs and lymph nodes. CS is clinically manifested in about 5% of patients with systemic sarcoidosis, but more than 25% may have evidence of cardiac involvement on autopsy or imaging studies [2] . There are no specific features of myocardial involvement pathognomonic for CS, which makes the diagnosis a challenging one.…”

Current State and Future Directions of Multimodality Imaging in Cardiac Sarcoidosis

“…Clinically, cardiac involvement may manifest with cardiomyopathy, arrhythmia, or atrioventricular conduction disease, or CS may remain relatively subclinical (2). While identifying CS has significant therapeutic and prognostic implications (5)(6)(7), diagnosis may be challenging, particularly in the absence of extracardiac disease.…”

The Effect of Pulmonary Sarcoidosis on Cardiac Autonomic Dysfunction

“…Although the lung and the lymphatic system are the most commonly involved, it affects multiple body systems and frequently young and middle-aged adults 2 . Clinical cardiac sarcoidosis can manifest with ventricular arrhythmias, conduction abnormalities, heart failure, and sudden death 3 . Heart rate (HR) varies as a result of respiration, thermoregulation, blood pressure regulation, the reninangiotensin system, circadian rhythms, and other factors 4 .…”