Cardiac Sarcoid

• heterogeneous, non-caseating, granulomatous disorder of unknown etiology (maybe environmental, occupational, infectious triggers)

• geographic variations 

  • Japan cardiac involvement 50-75%​

  • US cardiac involvement 15-50%

• clinical manifestations

  • conduction blocks​

  • tachyarrhythmias

  • cardiomyopathy

  • heart failure (especially in the young, middle aged)

  • sudden cardiac death

  • mitral incompetence

    • due to associated systolic dysfunction​ and left ventricular dilation

    • granuloma on papillary muscle 

    • can be severe enough to cause pulmonary hypertension requiring mitral valve replacement

    • tricuspid regurgitation with AV block secondary to infiltration has been reported

• Treatment

  • glucocorticoids​

  • immunomodulating (steroid sparing) agents

  • pacing / ICD

  • ablation

  • transplant