Cardiac sarcoidosis - an expert review for the chest physician

Area of Science:

• Cardiology
• Pulmonology
• Immunology

Background:

• Sarcoidosis is a multisystem granulomatous disease with lung predominance.
• Cardiac involvement (cardiac sarcoidosis, CS) elevates risks of cardiovascular disease, pulmonary hypertension, and sudden cardiac death.
• Chest physicians manage sarcoidosis and must understand cardiac involvement diagnosis and management.

Purpose of the Study:

• To outline diagnostic pathways for cardiac sarcoidosis.
• To describe initial management strategies for patients with cardiac involvement.
• To highlight the importance of early detection and treatment of CS.

Main Methods:

• Review of clinical presentation, diagnostic modalities (ECG, signal-averaged ECG, echocardiography), and treatment options for CS.
• Discussion of screening pathways and their limitations.
• Emphasis on the role of immunosuppression and arrhythmia management.

Main Results:

• Cardiac sarcoidosis can lead to ventricular tachyarrhythmias, atrioventricular block, atrial arrhythmias, and heart failure.
• A combination of history, clinical examination, and ECG detects up to 85% of CS cases.
• Advanced imaging and electrophysiological testing aid definitive diagnosis.
• Early immunosuppression reduces conduction abnormalities and supraventricular arrhythmias.
• Ventricular arrhythmias require antiarrhythmic drugs, ablation, and potentially ICD implantation.

Conclusions:

• Cardiac sarcoidosis poses significant risks, including sudden cardiac death.
• Multimodality diagnosis and timely, appropriate management are essential.
• Ongoing trials aim to refine screening and management guidelines for CS.