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cardiac sarcoidosis
Epidemiology:
- 25% of cardiac sarcoidosis are isolated to the heart
Clinical manifestations:
- dilated cardiomyopathy, LV systolic dysfunction (HFrEF)
- Mobitz type-2 second degree AV block or third degree heart block
- left bundle branch block
- sustained monomorphic ventricular tachycardia
Special laboratory:
- endomyocardial biopsy
- most specfid test, but sensitivity is low
Radiology:
- cardiac magnetic resonance imaging (CMRi)
- dilated cardiomyopathy [1]
- suspected restrictive cardiomyopathy [1]
- delayed gadolinium hyperenhancement generally of the mid myocardial wall or epicardium
- findings indicative of inflammation in distribution atypical for coronary artery disease [1]
- also useful for excluding constrictive pericarditis
- 18F-fluorodeoxyglucose (FDG) PET scan if CMRi is negative
Management:
- treat LV systolic dysfunction (HFrEF)
- cardiac rhythm reassessment prior to starting antiarrhythmic therapy
- if active inflammation, immunosuppressive therapy may improve arrhythmias
- glucocorticoids are first-line treatment [2,3]
General
sarcoidosis
dilated cardiomyopathy
References
- Markatis E, Afthinos A, Antonakis E et al.
Cardiac sarcoidosis: diagnosis and management.
Rev Cardiovasc Med. 2020;21:321-38.
PMID: 33070538
- Cheng RK, Kittleson MM, Beavers CJ et al; American Heart Association Heart Failure
and Transplantation Committee of the Council on Clinical Cardiology, and Council
on Cardiovascular and Stroke Nursing
Diagnosis and Management of Cardiac Sarcoidosis: A Scientific Statement From
the American Heart Association.
Circulation. 2024 Apr 18.
PMID: 38634276 Review.
- Medical Knowledge Self Assessment Program (MKSAP) 20
American College of Physicians, Philadelphia 2025
- Trivieri MG, Spagnolo P, Birnie D, et al.
Challenges in cardiac and pulmonary sarcoidosis: JACC state-of-the-art review.
J Am Coll Cardiol. 2020;76:1878-1901.
PMID: 33059834