Cardiac sarcoidosis: a comprehensive review

Abstract

Sarcoidosis is a multisystem granulomatous disease of unknown etiology characterized by noncaseating granulomas in involved organs. Organs involved with sarcoidosis include lymph nodes, skin, lung, central nervous system, and eye. Only 40-50% of patients with cardiac sarcoidosis diagnosed at autopsy have the diagnosis made during their lifetime. Cardiac sarcoidosis can manifest itself as complete heart block, ventricular arrhythmias, congestive heart failure, pericardial effusion, pulmonary hypertension, and ventricular aneurysms. Diagnostic tests such as the electrocardiogram, two-dimensional echocardiography, cardiac magnetic resonance imaging, positron emission tomography scan, radionuclide scan, and endomyocardial biopsy can be helpful in the early detection of cardiac sarcoidosis. Considering the increased risk of sudden death, cardiac sarcoidosis is an indication for early treatment with corticosteroids or other immunosuppressive agents. Other treatments include placement of a pacemaker or implantable defibrillator to prevent sudden death. In refractory cases, cardiac transplantation should be considered.

Keywords: cardiac sarcoidosis; noncaseating granulomas; sarcoidosis.

Figure 1

This figure illustrates the pathogenesis of cardiac sarcoidosis

Figure 2

This figure illustrates complete heart block with an atrial rate of 76 beats per minute and an idioventricular pacemaker with a ventricular rate of 26 beats per minute

Figure 3

This figure is a 2-dimensional echocardio -gram showing a dilated cardiomyopathy. The left ventricular internal dimension at the end of diastole is 6.6 cm