Cardiac sarcoidosis affects the heart in five to 25 percent of all sarcoidosis cases, prompting a range of symptoms from none at all to an irregular heartbeat, shortness of breath, leg swelling or, in rare cases, chest pain. Because all these symptoms are indicative of many different conditions, physicians suspecting cardiac sarcoidosis typically run a battery of tests that first exclude other diseases.
DIAGNOSIS: A cardiac biopsy is one of the few ways to confirm the diagnosis, although a cardiac MRI can sometimes detect the granularcells, which resemble clumps of sand or salt grains and eventually influence organ function. About one-third of the patients with cardiac sarcoidosis have detectable abnormalities visible in an echocardiogram. Other diagnostic tests include nuclear imaging and cardiac positron emission tomographic scans, also known as PET scans.
Although sarcoidosis can wax and wane, cycling through active and inactive phases, it usually occurs in more than one organ at a time. Effects on the heart can range from undetectable to severe. Potential problems include abnormal heart rhythm, blood flow blockages, heart failure and valve malfunctions.
TREATMENT: The primary difference when treating patients with cardiac sarcoidosis compared to most other cardiac conditions is that immunosuppressive therapy is often required in addition to standard medical and device therapy. The cornerstone for immunosuppressive therapy is corticosteroid treatment; however, steroid-sparing agents are also commonly co-administered to reduce side-effects.
Cardiac device therapy has evolved over time such that many more patients are now receiving pacemakers or implantable cardiac defibrillators for primary prevention of sudden death. Steroids are used to help reduce inflammation. Prednisolone is usually used and generally needed for a course of six to 24 months.