Editorials

Cardiac sarcoidosis

BMJ 1997; 314 doi: https://doi.org/10.1136/bmj.314.7077.320 (Published 01 February 1997) Cite this as: BMJ 1997;314:320

A potentially fatal condition that needs expert assessment

  1. D N Mitchell, Honorary consultant physiciana,
  2. R M du Bois, Consultant respiratory physiciana,
  3. P J Oldershaw, Consultant cardiologista
  1. a Directorates of Respiratory Medicine and Cardiology, Royal Brompton Hospital, London SW3 6NP

    Cardiac arrhythmias and sudden death are likely among patients known to have cardiac lesions from sarcoidosis. Other clinical presentations include conduction defects, congestive heart failure, and a picture suggesting myocardial infarction–but the first evidence of cardiac sarcoidosis may be provided by a pathologist after the sudden death of someone who had been completely free of symptoms.1

    Attempts have been made to assess the prevalence of cardiac sarcoidosis. Mikhail et al studied 147 consecutive patients presenting with sarcoidosis and found 14 with electrocardiographic abnormalities; 10 of these had no symptoms related to the heart.2 Stein et al surveyed 80 selected patients aged under 40 years, of whom only five were white and 47 had chronic disease.3 Electrocardiographic abnormalities of conduction or repolarisation were detected in 41 of these 80 patients, none of whom had cardiac symptoms.

    In two other large series of unselected patients the proportion with clinical evidence of granulomatous changes in the heart was small. Scadding and Mitchell reported that, of 500 consecutive patients under their care, only four showed such evidence.1 In the series of 702 …

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