Cardiac manifestations of sarcoidosis are present in up to 25% of patients with sarcoidosis, but only 5-10% of patients are symptomatic 1-2.
Sarcoidosis is a multisystem disorder characterised by the presence of non-caseating granulomas. For a general discussion of this condition please refer to the main sarcoidosis article.
Over half of patients with autopsy-proven cardiac involvement are asymptomatic. Symptoms include 1,4:
- arrhythmias including sudden death (most common) and heart block
- congestive cardiac failure
- angina pectoris (i.e. chest pain), palpitations and syncope
- ventricular aneurysm formation
Cardiac sarcoidosis is an inflammatory process that results in scarring, most commonly of the interventricular septum, posterior left ventricle, right ventricle, and anterior left ventricle 4. Cardiomegaly is often frequently present 4.
Although the disease may involve either the left or the right ventricle, the left ventricle is involved most commonly.
- rarely seen on CT; myocardial thinning may be the only sign 3 although extra-cardiac thoracic manifestations may be present (i.e. pulmonary changes, lymphadenopathy)
- cardiomegaly, pericardial effusions and ventricular aneurysms may also be present 4
The modality of choice. Common MRI findings in patients with cardiac sarcoid include:
- delayed enhancement, which may be either mid-wall or transmural
- nodular mid-wall hyperintense foci on black blood T2-weighted imaging
- areas of focal myocardial thickening
Treatment and prognosis
Cardiac sarcoidosis may account for around 13-25% of deaths from sarcoidosis. Early treatment options include corticosteroids or other immunosuppressive agents. Other treatments would include placement of a pacemaker or implantable defibrillator to prevent sudden death. In refractory cases, cardiac transplantation may be an option.
- 1. Miller BH, Rosado-de-christenson ML, Mcadams HP et-al. Thoracic sarcoidosis: radiologic-pathologic correlation. Radiographics. 1995;15 (2): 421-37. Radiographics (abstract) - Pubmed citation
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- 4. Jeudy J, Burke AP, White CS et-al. Cardiac sarcoidosis: the challenge of radiologic-pathologic correlation: from the radiologic pathology archives. Radiographics. 2015;35 (3): 657-79. doi:10.1148/rg.2015140247 - Pubmed citation
- 5. Hulten E, Aslam S, Osborne M, Abbasi S, Bittencourt MS, Blankstein R. Cardiac sarcoidosis-state of the art review. Cardiovascular diagnosis and therapy. 6 (1): 50-63. doi:10.3978/j.issn.2223-3652.2015.12.13 - Pubmed
- 6. Perez IE, Garcia MJ, Taub CC. Multimodality Imaging in Cardiac Sarcoidosis: Is There a Winner?. Current cardiology reviews. 12 (1): 3-11. Pubmed
- 7. Sekhri V, Sanal S, Delorenzo LJ, Aronow WS, Maguire GP. Cardiac sarcoidosis: a comprehensive review. Archives of medical science : AMS. 7 (4): 546-54. doi:10.5114/aoms.2011.24118 - Pubmed
- systemic manifestations
- pulmonary and mediastinal manifestations (chest x-ray staging)
- cardiac manifestations
- musculoskeletal manifestations
- head and neck manifestations
- central nervous system manifestations
- abdominal manifestations
- cutaneous manifestations