Pathophysiology and clinical management of cardiac sarcoidosis

Abstract

Cardiac sarcoidosis is a potentially life-threatening condition characterized by formation of granulomas in the heart, resulting in conduction disturbances, atrial and ventricular arrhythmias, and ventricular dysfunction. The presentation of cardiac sarcoidosis ranges from asymptomatic with an abnormal imaging scan, to palpitations, syncope, symptoms of congestive heart failure, and sudden cardiac death. Screening for cardiac sarcoidosis has not been standardized, but the presence of cardiac symptoms on medical history and physical examination, and an abnormal electrocardiogram (ECG), Holter monitoring, or echocardiogram has been shown to be highly sensitive for detecting cardiac sarcoidosis. A signal-averaged ECG might also have a role in screening for cardiac sarcoidosis in asymptomatic patients. Although endomyocardial biopsies are highly specific for the diagnosis of cardiac sarcoidosis, procedural yield is very low and appropriate findings on cardiac MRI or PET are, therefore, often used as diagnostic surrogates. Treatment for cardiac sarcoidosis usually involves immunosuppressive therapy, particularly corticosteroids. Additional therapy might be required, depending on the clinical presentation, including implantation of an internal defibrillator, antiarrhythmic agents, and catheter ablation.

European Heart Rhythm Association/Heart Failure Association joint consensus document on arrhythmias in heart failure, endorsed by the Heart Rhythm Society and the Asia Pacific Heart Rhythm Society

“…69,134,135 Pathophysiology-a brief overview Arrhythmogenesis in cardiac remodelling and chronic heart failure Ventricular arrhythmias are an important mechanism to explain SCD in the HF population. 69,134,135 Pathophysiology-a brief overview Arrhythmogenesis in cardiac remodelling and chronic heart failure Ventricular arrhythmias are an important mechanism to explain SCD in the HF population.…”

Cardiac sarcoidosis resembling panic disorder: a case report

“…According to autopsy reports of patients with sarcoidosis, cardiac involvement is present in at least 27% of cases [12], but cardiac sarcoidosis is clinically observed in only 5% of patients [13]. This finding indicates that many cardiac lesions are overlooked ante mortem [2, 14]. In our case, echocardiography revealed basal thinning of the interventricular septum, a characteristic feature of cardiac sarcoidosis, which served as the steppingstone that led to the accurate diagnosis of this condition [15, 16].…”

Management of extrapulmonary sarcoidosis: challenges and solutions

“…The possibility of cardiac sarcoidosis should be considered in: 1) adults under 55 years of age with new-onset electrocardiogram abnormalities, decreased systolic ejection fraction, or cardiac symptoms after excluding coronary artery disease; 2) adults under 55 years of age with sustained atrioventricular block (second or third degree); 3) patients of any age with sustained ventricular tachycardia and/or cardiomyopathy; and 4) all patients with diagnosed sarcoidosis of other sites 73,75,76. The different proposed diagnostic criteria for cardiac sarcoidosis are shown in Table 2.…”