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Published on: November 18, 2018
Sarcoidosis of the heart
1Cardiac Department, Middlesex Hospital, London, U.K.
Insights
Patients with bilateral hilar lymphadenopathy (BHL) require annual monitoring. Those with systemic sarcoidosis, especially with cardiac involvement, face driving and flying restrictions due to potential long-term complications.
Area of Science:
- Pulmonary Medicine
- Cardiology
- Occupational Health
Background:
- Bilateral hilar lymphadenopathy (BHL) is a key indicator in sarcoidosis diagnosis.
- Sarcoidosis can affect multiple organs, including the heart, often with delayed manifestation.
- Assessing fitness for driving and flying requires careful consideration of sarcoidosis involvement.
Purpose of the Study:
- To outline follow-up protocols for patients with BHL alone.
- To define criteria for driving and flying certifications in systemic sarcoidosis patients.
- To address the challenges in diagnosing cardiac sarcoidosis and its implications.
Main Methods:
- Annual monitoring for BHL patients: chest X-ray, ECG, 24-h monitoring, exercise testing, lung function, thallium 201 scanning.
- Evaluation of systemic sarcoidosis patients for organ involvement, particularly cardiac.
- Review of existing guidelines for occupational fitness (driving, flying) based on disease status.
Main Results:
- Stable or regressing BHL without other organ involvement allows return to multicrew operations after two years or regression.
- Generalized sarcoidosis without cardiac involvement permits driving but restricts flying to multicrew operations indefinitely.
- Known cardiac sarcoidosis necessitates refusal of driving licenses (unless supervised) and flying certifications.
Conclusions:
- Rigorous annual monitoring is essential for BHL patients.
- Indefinite restrictions on flying are recommended for systemic sarcoidosis due to subclinical cardiac involvement risks.
- Cardiac sarcoidosis poses significant risks, mandating strict medical supervision and operational limitations.
Abstract:
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.
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