Chest
ReviewMyocardial Sarcoidosis
Section snippets
SARCOID LESION
The basic lesion of sarcoidosis is a noncaseating granuloma consisting of pale-pink epithelioid cells, occasional multinucleate giant cells, and a scanty rim of lymphocytes. Caseation is absent; occasionally fibrinoid necrosis may be seen, particularly in the areas where several granulomas have coalesced, and may be distinguished from caseation by the presence of a fine reticulin pattern on silver staining. In cardiac sarcoidosis the granulomas may be confluent and extensive or may be
CLINICAL PATTERNS OF CARDIAC DYSFUNCTION
The clinical manifestations depend on the location and extent of involvement of the myocardial tissue.
Awareness of the Problem
When confronted with complex and undiagnosed arrhythmias, conduction disease, or congestive heart failure in a young or middle-aged person, the clinician should consider the possibility of sarcoid heart disease. Diagnosis depends on recognizing the multisystem nature of sarcoidosis and then seeking histologic proof of the pathology either in the myocardium or in other organs.32, 33
Physical Examination
The physician should seek out evidence of other organ system involvement, including lymphadenopathy, hepatomegaly,
TREATMENT OF CARDIAC SARCOIDOSIS
The specific therapy depends on the mode of presentation.
PROGNOSIS IN CARDIAC SARCOIDOSIS
Roberts and associates9 concluded that after the development of cardiac symptoms and signs, the survival in most patients was limited to about two years. According to Fleming69 the prognosis is not nearly so disastrous; over 100 of his patients have survived more than 5 years, 36 for more than 10 years, and 7 for more than 20 years. The major causes of death include sudden death due to ventricular tachyarrhythmias or conduction block and congestive heart failure.70, 71, 72 Early diagnosis and
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