Cardiac Involvement in Sarcoidosis: Evolving Concepts in Diagnosis and Treatment

Abstract

Clinically evident sarcoidosis involving the heart has been noted in at least 2 to 7%

Indirect pathological indicators for cardiac sarcoidosis on endomyocardial biopsy

“…The macroscopic distribution of cardiac lesions in our cases matches very well with the radiologic findings. There were scattered macroscopic fibrotic scars in the ventricular septum, free wall, sub-epicardium, and papillary muscles without any matching distribution in the coronary arterial supply [ 10 , 18 , 26 ]. This random pattern was also present in the autopsied heart with classical histologic features of sarcoidosis.…”

“…The clinical diagnosis of "probable involvement" requires histologic confirmation of extracardiac sarcoidosis. The Japanese Guidelines for Diagnosis of Cardiac Sarcoidosis based on the Study Report on Diffuse Pulmonary Diseases by the Japanese Ministry of Health is more practical for clinical decisions, and the presence of "interstitial fibrosis or monocyte infiltrate over moderate grade" was included as additional minor criteria [10,14]. Based on the current statement, we can only confirm the diagnosis of cardiac sarcoidosis when a granuloma is observed.…”

“…The incidence in autopsy series was 20% in a 1952 study [ 7 ], but recent studies have demonstrated variable incidences of 27% [ 8 ], 76% in Caucasian patients [ 4 ], and 80% in Japanese patients [ 9 ]. This variability in incidence may be real; partly due to racial differences in prevalence and due to the development of diagnostic techniques such as the endobronchial ultrasound or cardiac positron emission tomography (PET) [ 10 ]. But it may also be related to the variable application of the current diagnostic criteria [ 1 , 11 ].…”

Sarcoidosis: An FP’s primer on an enigmatic disease

“…The diagnosis of sarcoidosis can be difficult and delayed due to diverse organ involvement and nonspecific presentations. TABLE 1 [21][22][23][24][25][26][27][28][29][30][31] shows the diverse manifestations in a patient with suspected sarcoidosis. Around 50% of the patients are asymptomatic.…”

“…Occasionally both anterior/posterior uveitis 29 Eye pain, red eyes, blurry vision, floaters, photophobia, visual loss 25,30 More common in women 31 Renal Calcium disorders 7% 22 10%-40% 21,23,25 Renal failure due to granulomatous nephritis can occur 22,24 Asymptomatic hypercalciuria (most common), hypercalcemia, renal calculi 22,25 Hematuria, abdominal pain…”