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Sarcoid heart disease.

Jaffer Syed¹, Robert Myers

¹Internal Medicine and Cardiology, University of Toronto, Toronto, Ontario, Canada.

The Canadian Journal of Cardiology

|February 18, 2004

Summary

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Sarcoid heart disease diagnosis is challenging but crucial, often requiring imaging and clinical suspicion. Early treatment with steroids and device therapy can manage symptoms and improve outcomes.

Area of Science:

Cardiology
Immunology
Internal Medicine

Background:

Sarcoidosis is a multisystem inflammatory disease with unknown etiology.
Its diverse clinical presentations complicate diagnosis and treatment strategies.
Prognosis for sarcoidosis, particularly cardiac involvement, remains poorly defined.

Purpose of the Study:

To conduct a literature review on sarcoid heart disease.
To outline an approach for diagnosing cardiac sarcoidosis.
To discuss prognostic factors and therapeutic options for sarcoid heart disease.

Main Methods:

Comprehensive searches of MEDLINE and PreMEDLINE databases.
Inclusion of English-language articles and case reports from 1966 to 2002.
Utilized search terms 'sarcoidosis' and 'heart diseases' with relevant subheadings.

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Main Results:

Common manifestations include heart block, dilated cardiomyopathy, and ventricular arrhythmias, increasing sudden death risk.
Diagnosis relies on a combination of ECG, Holter monitoring, echocardiography, nuclear imaging, and MRI due to low biopsy yield.
Therapies include steroids, immunosuppressants, TNF inhibitors for refractory cases, pacemakers for heart block, and ICDs for ventricular arrhythmias.

Conclusions:

Diagnosis of cardiac sarcoidosis is clinically significant despite limited trial data.
Cardiac involvement indicates a poorer prognosis compared to isolated pulmonary sarcoidosis.
Diagnosis requires high clinical suspicion, imaging, and prompt management with steroids and device therapy for arrhythmias.