IMR Press / RCM / Volume 25 / Issue 2 / DOI: 10.31083/j.rcm2502037
Open Access Review
Cardiac Sarcoidosis: A Comprehensive Clinical Review
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1 Department of Medicine and Hematology, Semmelweis University, 1088 Budapest, Hungary
2 Department of Nuclear Medicine, University of Szeged, 6720 Szeged, Hungary
3 Division of Non-Invasive Cardiology, Department of Medicine, University of Szeged, 6720 Szeged, Hungary
4 Department of Pathology, University of Szeged, 6720 Szeged, Hungary
5 Heart and Vascular Center, Semmelweis University, 1122 Budapest, Hungary
*Correspondence: vereckei.andras@med.semmelweis-univ.hu (András Vereckei)
Rev. Cardiovasc. Med. 2024, 25(2), 37; https://doi.org/10.31083/j.rcm2502037
Submitted: 27 June 2023 | Revised: 29 October 2023 | Accepted: 7 November 2023 | Published: 29 January 2024
Copyright: © 2024 The Author(s). Published by IMR Press.
This is an open access article under the CC BY 4.0 license.
Abstract

Sarcoidosis is an inflammatory multisystemic disease of unknown etiology characterized by the formation of non-caseating granulomas. Sarcoidosis can affect any organ, predominantly the lungs, lymphatic system, skin and eyes. While >90% of patients with sarcoidosis have lung involvement, an estimated 5% of patients with sarcoidosis have clinically manifest cardiac sarcoidosis (CS), whereas approximately 25% have asymptomatic, clinically silent cardiac involvement verified by autopsy or imaging studies. CS can present with conduction disturbances, ventricular arrhythmias, heart failure or sudden cardiac death. Approximately 30% of <60-year-old patients presenting with unexplained high degree atrioventricular (AV) block or ventricular tachycardia are diagnosed with CS, therefore CS should be strongly considered in such patients. CS is the second leading cause of death among patients affected by sarcoidosis after pulmonary sarcoidosis, therefore its early recognition is important, because early treatment may prevent death from cardiovascular involvement. The establishment of isolated CS diagnosis sometimes can be quite difficult, when extracardiac disease cannot be verified. The other reason for the difficulty to diagnose CS is that CS is a chameleon of cardiology and it can mimic (completely or almost completely) different cardiac diseases, such as arrhythmogenic cardiomyopathy, giant cell myocarditis, dilated, restrictive and hypertrophic cardiomyopathies. In this review article we will discuss the current diagnosis and management of CS and delineate the potential difficulties and pitfalls of establishing the diagnosis in atypical cases of isolated CS.

Keywords
sarcoidosis
cardiac sarcoidosis
granulomatous disease
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