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Cardiac sarcoidosis

INTRODUCTION

Cardiac sarcoidosis can be a benign, incidentally discovered condition or a life-threatening disorder. Clinical evidence of myocardial involvement is present in approximately 5 percent of patients with sarcoidosis, although autopsy studies indicate that subclinical cardiac involvement is present in 20 to 30 percent of cases [1-3].

The clinical features, diagnosis, and management of cardiac sarcoidosis will be reviewed here. General issues related to sarcoidosis are discussed separately. (See "Clinical manifestations and diagnosis of sarcoidosis" and "Pathogenesis of sarcoidosis".)

The American Thoracic Society (ATS) statement on sarcoidosis, as well as other ATS guidelines, can be accessed through the ATS web site at www.thoracic.org/statements.

CLINICAL MANIFESTATIONS

Clinical manifestations of cardiac sarcoidosis depend upon the location and extent of granulomatous inflammation. Cardiac involvement may precede, follow, or occur concurrently with involvement of the lungs or other organs. Clinicians should consider the possibility of sarcoid heart disease in the evaluation of an otherwise healthy young or middle-aged person with cardiac symptoms, or in a patient with known sarcoidosis who develops arrhythmias, conduction disease, or heart failure. Overall, it is estimated that cardiac involvement occurs in about 25 percent of patients with sarcoidosis although data are limited.

Myocardial involvement is common in patients with sarcoidosis who have cardiac symptoms and unusual in those without such symptoms. This was illustrated in a report of 101 patients with biopsy proven pulmonary sarcoidosis, 19 of whom presented with cardiac symptoms [4]. An electrocardiogram (ECG) was performed in all patients and most patients underwent further cardiac evaluation with echocardiography, radionuclide myocardial perfusion imaging, cardiac magnetic resonance imaging, and, in a few cases, coronary angiography and/or endomyocardial biopsy. Cardiac sarcoidosis was diagnosed much more frequently in symptomatic patients (84 versus 4 percent). Sudden cardiac death may be a presenting feature.

                           

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Literature review current through: 20.3: Jan 2012
This topic last updated: Feb 18, 2011
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