cardiac sarcoidosis

Epidemiology

• 25% of cardiac sarcoidosis are isolated to the heart

Clinical manifestations

• dilated cardiomyopathy, LV systolic dysfunction (HFrEF)
• Mobitz type-2 second degree AV block or third degree heart block
  • left bundle branch block
• sustained monomorphic ventricular tachycardia

Diagnostic procedures

• endomyocardial biopsy
  • most specfid test, but sensitivity is low

Radiology

• cardiac magnetic resonance imaging (CMRi)
  • dilated cardiomyopathy
  • suspected restrictive cardiomyopathy
    • delayed gadolinium hyperenhancement generally of the mid myocardial wall or epicardium
    • findings indicative of inflammation in distribution atypical for coronary artery disease
    • also useful for excluding constrictive pericarditis
• 18F-fluorodeoxyglucose (FDG) PET scan if CMRi is negative

Management

• treat LV systolic dysfunction (HFrEF)
• cardiac rhythm reassessment prior to starting antiarrhythmic therapy
• if active inflammation, immunosuppressive therapy may improve arrhythmias

More general terms

• sarcoidosis
• dilated cardiomyopathy