[Heart failure, skin manifestations, enlarged hilar lymph nodes. Is it sarcoidosis?]

Sarcoidosis is defined as a multisystem disease of unknown genesis that affects in particular the middle-aged. In 80% of the cases, the acute form is associated with pulmonary manifestations, and in the majority of patients clears up--even in the absence of treatment--with no sequelae. The chronic version is characterized by the development of multiple pulmonary granulomas and progressive fibrosis. Subsequently, emphysema, cor pulmonale and right heart insufficiency develops. Almost 50% of chronic sarcoidosis patients have cardiac involvement with arrhythmias, heart block and the clinical picture of a cardiomyopathy, which in many cases leads to death--acutely (sudden cardiac death) or over the longer term. In manifest disease, treatment with steroids should be initiated and continued over a year. Conduction disorders require the implantation of a pacemaker.