Cardiac sarcoidosis: from early recognition to management

Cardiac sarcoidosis is a potentially fatal inflammatory disorder with the tendency to mostly affect the myocardial tissues. It is commonly associated with extra-cardiac structures such as the lungs and the thoracic lymph nodes; however, when it manifests as an isolated disease, it can be insidious. The clinical presentation is variable depending on the location and extent of the cardiac tissues involved, including asymptomatic cases, conduction abnormalities, arrhythmia, heart failure and sudden cardiac death (SCD). It is an enigmatic disease to diagnose owing to the variable clinical presentation; as a result, most centres are adopting a multidisciplinary approach to diagnosis, risk stratification and management. The mainstay of treatment in CS is immunosuppression, guideline-directed medical therapy for patients with heart failure in addition to device therapy for individuals at high risk of SCD, and heart transplantation for patients with advanced heart failure. We synthesise the existing evidence in the diagnosis and management of cardiac sarcoidosis in our review.