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[Cardiac sarcoidosis: diagnostics, treatment and follow-up]
Maria Dudziak1, Hanna Jankowska1, Karolina Dorniak1
1Department of Noninvasive Cardiac Diagnostic, 2nd Chair of Cardiology and Electrotherapy, Medical University of Gdansk, Poland.
Insights
Cardiac sarcoidosis, a granulomatous disorder, can impact the heart, leading to various complications. Early screening and tailored treatments, including steroids and advanced therapies, are crucial for managing this condition and preventing sudden cardiac death.
Area of Science:
- Cardiology
- Immunology
- Pulmonology
Background:
- Sarcoidosis is a systemic granulomatous disease of unknown cause.
- Cardiac involvement is a serious manifestation, affecting heart function and potentially leading to sudden death.
Purpose of the Study:
- To outline the diagnostic and therapeutic strategies for cardiac sarcoidosis.
- To emphasize the importance of screening for cardiac involvement in patients with extracardiac sarcoidosis.
Main Methods:
- Screening involves standard ECG, 24-hour Holter monitoring, and echocardiography.
- Advanced diagnostic methods are employed when initial tests reveal abnormalities.
- Treatment strategies include corticosteroids, immunosuppressants, heart failure management, and device implantation.
Main Results:
- Cardiac sarcoidosis presents a wide clinical spectrum, from asymptomatic cases to sudden cardiac death.
- Early detection through screening is vital for timely intervention.
- Multifaceted treatment approaches are necessary for effective management.
Conclusions:
- Cardiac sarcoidosis requires a comprehensive diagnostic and therapeutic approach.
- Proactive screening and management can mitigate risks associated with cardiac sarcoidosis.
- Advanced therapies like pacemakers, ICDs, and heart transplantation are indicated for severe cases.
Abstract:
Sarcoidosis is a generalised granulomatous disorder of unknown aetiology. Cardiac involvement may affect conduction system, myocardium, valvular apparatus and pericardium. Clinical spectrum ranges from asymptomatic involvement to sudden cardiac death. Patients with biopsy-proven extracardiac sarcoidosis should be screened for cardiac involvement (standard ECG, 24-hour Holter ECG, echocardiography) and in case of any abnormalities found on these tests, more advanced diagnostic methods should be used. Steroid treatment is still the mainstay of therapy in cardiac sarcoidosis. Several immunosuppresive agents are also effective and used in different combinations with steroids, as well as heart failure treatment (including ACE inhibitors, angiotensin receptor blockers, beta-blockers and diuretics). Advanced heart block requires pacemaker implantation, and implantable cardioverterdefibrillator is an effective treatment in primary and secondary prophylaxis of sudden cardiac death. Heart transplantation is considered in advanced, drug-resistant heart failure or incessant ventricular arrhythmias unresponsive to other forms of therapy.
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