Walsh & Hoyt: Sarcoidosis: Cardiac Manifestations

Cardiac manifestations of sarcoidosis may be primary or secondary in etiology. Chronic pulmonary hypertension and cor pulmonale are frequent complications of persistent severe pulmonary disease in patients with sarcoidosis. Only 5% of patients have overt disease, even though 2025% of sarcoid patients have cardiac involvement at autopsy. Myocardial granulomatous disease may cause conduction block, tachyarrhythmias, myocarditis, and sudden death, and granulomatous infiltration of cardiac trabeculae and valves may produce regurgitation of the mitral or aortic valves. Cardiac sarcoidosis can be difficult to diagnose, and the significant risk of sudden death in symptomatic patients emphasizes the need for aggressive management that may include medical therapy, pacemaker use, or the insertion of an automated implantable defibrillator. Patients may ultimately need cardiac transplantation.