[Four cases of myocardial sarcoidosis]

We reported 4 cases diagnosed as myocardial sarcoidosis. One of them was diagnosed by endomyocardial biopsy, however, the others were diagnosed by cardiological findings and biopsy of the scalene node, liver or skin. Analysis of ECG findings showed conduction disturbances in all cases and disorders of impulse formation in two. Thallium 201 myocardial perfusion scans (T1 scan) revealed inferior and anteroseptal wall defects in case 4 and entire heterogenous defect in case 2. And also in case 2, left ventricular perfusion defect detected in T1 scan before steroid therapy changed to entire heterogenous defect. Thus, T1 scan was thought to be useful for the evaluation of therapy and for follow up study of myocardial sarcoidosis. In the cardiac echogram, thickening of the wall was seen in cases 3 and 4, and dilated ventricle in another case. Steroid was given in all cases and a pacemaker was implanted in two cases. The therapy was effective in all cases and ECG abnormalities were improved. In one case (Case 3) treated by a pacemaker steroid administration was halted and subsequently developed heart failure, but the other (Case 1) continued treatment with steroid caused return to a natural beat. Thus steroid therapy with a pacemaker implantation was considered to be effective for severe myocardial sarcoidosis.