Sarcoidosis can present with angina like chest pain but it is an uncommon presentation and likely is a result of a vasculitis. In a patient presenting with angina – CAD would be the first consideration
Pericarditis is also a cause of chest pain in sarcoidosis but this is also uncommon
Patients who have been studied have shown a positive thallium exercise test but with negative angiography
20-25% of patients with sarcoidosis have cardiac sarcoid based on post mortem studies In Japan it may be as high as 50%
Most patients with cardiac sarcoidosis present either with an arrhythmia (heart block or tachyarrhythmia) or sudden death.
Those with a cardiomyopathy or valvular involvement may present with heart failure
The range of sarcoid involvement of the heart includes heart block and arrhythmias (due to involvement of the conducting system), heart failure, valvular dysfunction, simulated infarction, and pericardial disease
While the ventricular myocardium is most commonly affected, involvement by the atria, papillary muscles, valves, coronary arteries, and pericardium has been described.