Chest
Volume 103, Issue 1, January 1993, Pages 253-258
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Review
Myocardial Sarcoidosis

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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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REFERENCES (72)

  • SJ Ratner et al.

    Utility of endocardial biopsy in the diagnosis of cardiac sarcoidosis

    Chest

    (1986)
  • T Ishikawa et al.

    Steroid therapy in cardiac sarcoidosis: increased left ventricular contractility concomitant with electrocardiographic improvement after prednisone

    Chest

    (1984)
  • SL Demeter

    Myocardial sarcoidosis unresponsive to steroids: treatment with cyclophosphamide

    Chest

    (1988)
  • EE Lower

    Baughman RP The use of low dose methotrexate on refractory sarcoidosis

    Am J Med

    (1990)
  • EL York et al.

    Cyclosporine and chronic sarcoidosis

    Chest

    (1990)
  • PhinneyAO

    Sarcoid of the myocardial septum with complete heart block: report of two cases

    Am Heart J

    (1961)
  • PL Huang et al.

    Antiarrhythmic therapy guided by programmed electrical stimulation in cardiac sarcoidosis with ventricular tachycardia

    Am Heart J

    (1991)
  • RJ Lull et al.

    Ventricular aneurysm due to cardiac sarcoidosis with surgical cure of refractory ventricular tachycardia

    Am J Cardiol

    (1972)
  • DH Antecol et al.

    Sudden death behind the wheel from natural disease in drivers of four wheeled motorized vehicles

    Am J Cardiol

    (1990)
  • GS Flora

    Sharma OP Myocardial sarcoidosis

    Sarcoidosis

    (1989)
  • M Bernstein et al.

    Boeck's sarcoid: report of case with visceral involvement

    Arch Intern Med

    (1929)
  • C. Gentzen

    Uber Reisenzellengranulome bei zwei fallen von endocardiofibrose

    Beitr Pathol Anat

    (1937)
  • GH Porter

    Sarcoid heart disease

    N Engl J Med

    (1960)
  • Y Matsui et al.

    Clinicopathological study of fatal myocardial sarcoidosis

    Ann NY Acad Sci

    (1976)
  • KJ Silverman et al.

    Cardiac sarcoid: a clinicopathological study of 84 unselected patients with systemic sarcoidosis

    Circulation

    (1978)
  • HA Fleming

    Sarcoid heart disease

    Sarcoidosis

    (1985)
  • WC Roberts et al.

    Sarcoidosis of the heart: a clinicopathologic study of 35 necropsy patients (group I) and review of 78 previously described necropsy patients (group II)

    Am J Med

    (1976)
  • HA Fleming

    Sarcoid heart disease

    Br Heart J

    (1974)
  • P Ghosh et al.

    Myocardial sarcoidosis

    Br Heart J

    (1972)
  • N Seldguchi et al.

    Long term prognosis of cardiac sarcoidosis with permanent pacemaker implantation: a Japanese Study

  • AR Morales et al.

    Sarcoidosis and the heart

    Pathol Annu

    (1974)
  • MJ Walsh

    Systemic sarcoidosis with refractory ventricular tachycardia and heart failure

    Br Heart J

    (1978)
  • GA Serwer et al.

    Ventricular tachyarrhythmia due to cardiac sarcoidosis in a child

    Pediatrics

    (1978)
  • M Sekiguchi et al.

    Clinical and histological profile of sarcoidosis of the heart and acute idiopathic myocarditis: concepts through a study employing myocardial biopsy

    Jpn Circ J

    (1980)
  • HA Fleming

    Cardiac sarcoidosis

    Semin Respir Med

    (1986)
  • JL Wait et al.

    Anginal chest pain in sarcoidosis

    Thorax

    (1989)
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