Cardiac Sarcoidosis : Clinical Features

Comments:
Clinical Features: Symptomatic cardiac involvement occurs in about 5% of sarcoidosis patients. Clinically silent disease is believed to be present in about 25% of cases based on autopsy studies.

Cardiac sarcoidosis (CS) can be the first manifestation of systemic disease. The clinical features depend upon the extent and location of cardiac involvement as well as the activity of the disease. The predominant manifestations are conduction abnormalities and heart failure.

Conduction abnormalities usually present as complete atrioventricular block or ventricular tachycardia/fibrillation, both of which can be associated with sudden death (as was seen in the case illustrated here). Nonfatal cardiac manifestations include congestive heart failure, chest pain, and pericardial effusion. Patients with clinically manifest CS have minimal extracardiac disease and cardiac symptoms predominate over extracardiac manifestations.

The image shows multiple yellow-white infiltrates (microscopically - sarcoid granulomas with scarring) distributed throughout the myocardium. The patient was a 30 y/o who died suddenly unexpectedly due to cardiac sarcoidosis.

Image courtesy of: Megan Quinn, MD; used with permission.