Cardiac Sarcoid

last updated: November 4, 2016

Orlando Debesa

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

... but I would more especially commend the clinician who, in acute diseases, by which the bulk of mankind are cutoff, conducts the treatment better than others.
 
Hippocrates, 400 BC