Cardiac Sarcoidosis

A patient with sarcoidosis who suddenly faints may not be having a benign vasovagal episode. Granulomatous inflammation can infiltrate the atrioventricular conduction system, producing high-grade block, or create electrically unstable myocardium that supports sustained ventricular tachycardia. Either problem can cause sudden cardiac death. The pattern is easy to miss because cardiac involvement may be clinically silent, may appear before pulmonary disease, or may emerge after years of extracardiac sarcoidosis. The practical model is to ask two questions: Is the myocardium actively inflamed, and is there already a dangerous electrical or mechanical consequence? Active inflammation may improve with immunosuppression; established scar generally will not. Device decisions cannot be postponed while waiting to see whether steroids restore conduction.