The intricacies of cardiac sarcoidosis: a case report involving the coronary arteries and a review of the literature

Sudden cardiac death due to coronary artery dissection as a complication of cardiac sarcoidosis

“…Even more concerning is the existence of isolated cardiac involvement in which the nonspecific symptoms of lung involvement fail to manifest to encourage investigation [13]. Further research into the pathogenesis of sarcoidosis may yield an understanding of the context in which it arises; what is currently considered subclinical progression of cardiac involvement could potentially, in the future, be handily identified.…”

“…Cardiac involvement is a dreaded manifestation of disease; it is found in up to 30% of systemic sarcoidosis cases at autopsy and can lead to sudden cardiac death [13]. To further complicate matters, diagnosis of cardiac involvement in vivo by biopsy is technically difficult due to patchy distribution and predilection for affecting the left ventricle that is challenging to access [13].…”

Arrhythmogenesis and diagnosis of cardiac sarcoidosis. An immunohistochemical study in a sudden cardiac death

“…In a post-mortem study performed on 113 cases with cardiac sarcoidosis, has been reported that the left ventricular free wall is the most common location for granulomas and scars (98%), followed by interventricular septum (70%), right ventricle (68%) and atria (29%) [6]. Other authors described cases in which cardiac sarcoidosis involving the coronary arteries and myocardium [7], or right ventricle or mimicking ischemic ventricular arrhythmia and pulmonary embolism [8]. Therefore the clinical presentation are various and may include: conduction disorder from benign first degree AV block to complete heart block when there is the involvement of the basal intra-ventricular septum; ventricular arrhythmias [9] such as sustained or non-sustained ventricular tachycardia, frequent ventricular ectopy and premature ventricular complexes; congestive heart failure; atrial arrhythmias; pericarditis, cardiac tamponade and constrictive pericarditis and valvular dysfunction and sudden death.…”

Primary Cardiac Sarcoidosis with Syncope and Refractory Atrial Arrhythmia: A Case Report and Review of the Literature

“…17 Other rare presentations include extensive coronary artery involvement that presents with dyspnea, and thrombus formation in the atria and ventricles that presents with syncope. 11,12,14 The diagnosis of cardiac sarcoidosis can be based on histologic or clinical observations. Although the discovery of granulomatous inflammation with nonnecrotic centers is the gold standard, it is often difficult to obtain such conclusive biopsies.…”

“…Sarcoidosis can produce granulomatous inflammation in any area of the heart, including the endocardium, myocardium, pericardium, conduction system, coronary arteries, and vena cava. [11][12][13][14] Frequently, patients present with various degrees of heart block and arrhythmia, with generalized symptoms of weakness, dizziness, dyspnea, palpitation, or chest pain. 8 Arrhythmias are especially important because of their potential contribution to morbidity and death.…”