In people in the United States, sarcoidosis most commonly targets the lungs, but the disease can also affect the heart, a condition called cardiac sarcoidosis. Researchers who study sarcoidosis estimate that cardiac sarcoidosis affects more than 10 percent of sarcoidosis patients in the United States, and perhaps as many as 25 percent. For this reason, and because heart problems are serious and should be diagnosed and treated as early as possible, people who have sarcoidosis should discuss being screened for cardiac sarcoidosis with their doctors.

Sarcoidosis can affect any part of the heart, from the heart’s electrical signaling system to the heart muscle and valves and the layers of tissue that cover the heart. Although some people with cardiac sarcoidosis might notice symptoms of the condition, many people will feel nothing, which is why screening is so important.

SYMPTOMS

• irregular heartbeats, which can feel like palpitations and/or skipped beats.
• shortness of breath, coughing, chest tightness, and or wheezing, although these can be a sign of lung problems, too
• chest pain, although this symptom is rare
• swelling in the legs, which usually occurs only in late-stage cardiac sarcoidosis

The problems caused by cardiac sarcoidosis can include:

• arrhythmias, which are abnormal heartbeats or rhythms
• heart blocks, which occur when proper blood flow through the heart is blocked
• heart failure, which means the heart is unable to pump enough blood through the body, causing blood and fluid to back up in the lungs and elsewhere
• pericarditis, which, although rare, can cause inflammation of the covering of the heart, as well as chest pains
• heart valve problems, which are also rare but can cause abnormal functioning of the valves that normally keep the blood in your heart flowing in the right direction
• heart attacks, which are rare but can occur when a blockage prevents blood and oxygen from reaching part of the heart

DIAGNOSIS

Early diagnosis is the key to preventing the potentially devastating effects of cardiac sarcoidosis. Only a few people who have cardiac complications are at risk for the most serious effects, such as heart failure or sudden death, but these are risks. And because cardiac sarcoidosis is hard to notice, being checked for it is important if you already have sarcoidosis.

There is no one laboratory test that a doctor can use to diagnose cardiac sarcoidosis, and there are no official guidelines for doctors to tell them how to screen their patients for the condition. However, a number of laboratory tests and sophisticated imaging tools are available today that can detect various heart problems. Although these tests are not specific for sarcoidosis, the ones that your doctor recommends for you, taken together, can help give a more complete picture of your risk for cardiac complications.

Diagnostic Tests for Cardiac Sarcoidosis:

• Electrocardiography (ECG or EKG)
• Holter monitoring
• Echocardiography
• Nuclear imaging (with thallium and/or technetium sestamibi)
• Cardiac positron emission tomography (PET)
• Cardiac magnetic resonance imaging (MRI)
• Heart biopsy, rarely

TREATMENT

Most doctors treat cardiac sarcoidosis with corticosteroid medications, which are also called glucocorticoids or steroids. These are powerful drugs that can stop or prevent heart injury by reducing the inflammation caused by sarcoidosis. Commonly prescribed glucocorticoids include cortisone, prednisone, and prednisolone.

For people who cannot take corticosteroids, doctors might prescribe any of a host of other medications that suppress the immune system and reduce inflammation, such as antimalarials, methotrexate, azathioprine, and mycophenylate.

Antiarrhythmia drugs (heart drugs) may be given to correct irregular heartbeats or improve the heart’s pumping ability once inflammation has already seriously damaged the heart muscle.  For people with serious arrhythmias or heart blockages, a cardiac pace-maker (a small battery-operated device, often put under the skin, that regulates the heartbeat) or defibrillator (an implanted device that shocks a heart into a normal heartbeat or, if it has stopped, into beating) might also be recommended.  Rarely, heart transplantation may be indicated in the case of heart failure.

MORE INFORMATION

The preceding information relating to cardiac sarcoidosis is excerpted from the FSR publication 'Sarcoidosis and the Heart', © 2006.  Click Here to order your free copy.