Sarcoidosis of the heart.

Patients who have bilateral hilar lymphadenopathy (BHL) alone need annual follow-up with chest X-ray, ECG, 24-h monitoring, exercise testing, lung function and possible thallium 201 scanning. Provided these tests are normal or negative, there is no evidence of other organ or parenchymal lung involvement and the extent of BHL is stable or regressing, then restriction to multicrew operation should be required until regression has occurred or a period of two years has elapsed. Although a patient with generalized or systemic sarcoidosis and no apparent cardiac involvement should be allowed to drive a car, certification to fly should be dependent on physical well being and restricted to multicrew operation. With our present inability to diagnose cardiac involvement in sarcoidosis with complete sensitivity, this restriction should be indefinite as cardiac involvement in sarcoidosis may only become apparent many years after the diagnosis of systemic sarcoidosis has been made. Patients with known cardiac involvement in sarcoidosis should also be refused a driving licence unless they are under regular and close supervision for possible arrhythmic complications. Permanent pacing may be needed. Patients with known cardiac sarcoid should be refused certification to fly.