Cardiac manifestations of sarcoidosis and therapeutic options

Sarcoidosis is a multisystem disorder of unknown etiology, characterized by granulomatous infiltration and the development of noncaseating granulomas in many organ systems. Although the lungs, eyes, and skin are most commonly affected, virtually any body organ can be involved. Clinical evidence of sarcoid heart disease (SHD) is seen only in 5% of patients and the disease may present with tachyarrhythmias, conduction disturbance, heart failure, or sudden cardiac death. SHD may present at any age and occurs in all ethnic groups. Cardiac involvement, although typically silent, is an important prognostic factor in sarcoidosis. Various diagnostic tests such as the electrocardiogram, two-dimensional echocardiography, cardiac magnetic resonance imaging, positron emission tomography scan, radionuclide scan, and a transvenous endomyocardial biopsy are available for the early detection of cardiac involvement in sarcoidosis. Given that early diagnosis and treatment may prevent substantial morbidity and mortality in patients with cardiac involvement, it remains important to screen patients with sarcoidosis and initiate early treatment with corticosteroids. Other immunosuppressive agents, antiarrhythmic drugs, placement of an automated implantable cardiac defibrillator, or surgical options such as a pericardial window, ventricular aneurysm repair and cardiac transplant, may also be required for the management of patients with SHD.