Sarcoid heart disease

Although cardiac involvement in sarcoidosis is clinically rare (apparent in about 2%), much higher frequencies (around 25%) have been reported in autopsy studies (1,2)

Sarcoidosis may result in the replacement of myocardium with 'slabs' of granuloma.

• this may occur without causing heart failure, but instead, like an infarct, result in focal akinesia. The conducting tissue may also be affected.
• the most common localization for granulomas and scars is the left ventricular free wall, followed by the intraventricular septum, often the conducting system is affected as well (2).

Cardiac involvement is often both insidious and fatal (3). Screening at presentation should cover a detailed medical history, physical examination, and an electro cardiographic examination (4). All patients with cardiac symptoms (palpitations or abnormal ECG) should be referred to a specialist for further evaluation (1)

Sarcoid heart disease should be considered:

• if a patient with sarcoid is suffering from arrhythmias
• if there is focal involvement of the left ventricle without previous history of an infarct
• if ventricular arrhythmias or atrioventricular block occur at an unexpectedly early age

Note:

• clinicians should keep in mind that cardiac sarcoidosis often occurs in the absence of apparent disease elsewhere hence in any form of nonischemic cardiomyopathy particularly when rhythm disturbances are prominent, the possibility of sarcoidosis should be suspected (3).

Reference:

• (1) Dempsey OJ et al. Sarcoidosis. BMJ. 2009 Aug 28;339:b3206
• (2) Iannuzzi MC, Rybicki BA, Teirstein AS. Sarcoidosis. N Engl J Med. 2007;357(21):2153-65
• (3) Habersberger J et al. Cardiac sarcoidosis.Intern Med J. 2008;38(4):270-7.
• (4) Iannuzzi MC, Fontana JR. Sarcoidosis: clinical presentation, immunopathogenesis, and therapeutics.JAMA. 2011;305(4):391-9.