Journal of Cardiac and Pulmonary Rehabilitation
Open Access

Cardiac sarcoidosis is a rare and often underdiagnosed condition that affects the heart, posing serious health risks to individuals. Sarcoidosis itself is a complex autoimmune disease characterized by the formation of granulomas, small clumps of inflammatory cells, in various organs, including the lungs, skin, eyes, and lymph nodes. When sarcoidosis specifically affects the heart, it can lead to significant complications and impair cardiac function. In this article, we will explore the nuances of cardiac sarcoidosis, including its symptoms, diagnosis, and treatment options [1].

Symptoms

The symptoms of cardiac sarcoidosis can be quite diverse, making diagnosis challenging. Some individuals may experience no symptoms at all, while others may develop severe heart problems. Common symptoms of cardiac sarcoidosis include

Arrhythmias: Irregular heart rhythms are a hallmark of cardiac sarcoidosis. This can manifest as palpitations, skipped beats, or more serious arrhythmias like ventricular tachycardia [2].

Heart failure: As the disease progresses, it can weaken the heart muscle, leading to symptoms of heart failure such as fatigue, shortness of breath, and swollen ankles.

Chest pain: Cardiac sarcoidosis can cause chest pain that may mimic angina or heart attack symptoms.

Syncope: Fainting episodes may occur due to abnormal heart rhythms or reduced blood flow to the brain.

Edema: Swelling in the legs, ankles, or feet can develop as fluid accumulates in the body due to compromised cardiac function [3].

Peripheral edema: Swelling can also affect the arms or hands, especially in advanced cases.

Diagnosis

Diagnosing cardiac sarcoidosis can be challenging because its symptoms can mimic those of other heart conditions. A comprehensive diagnostic approach is crucial and may involve the following:

Medical history and physical examination: Your doctor will inquire about your medical history and perform a physical examination to identify any signs or symptoms of cardiac sarcoidosis [4].

Electrocardiogram (ECG or EKG): This test can detect abnormal heart rhythms and changes in the heart's electrical activity, which may suggest cardiac sarcoidosis.

Echocardiography: An echocardiogram provides detailed images of the heart's structure and function. It can reveal signs of inflammation or heart muscle damage.

Cardiac MRI: This imaging technique can help visualize inflammation and scarring in the heart, providing valuable information for diagnosis [5].

Biopsy: In some cases, a biopsy of heart tissue may be necessary to confirm the presence of granulomas, although this procedure is not always performed due to its invasive nature.

FDG-PET scanning: Positron emission tomography (PET) with fluorodeoxyglucose (FDG) can highlight areas of inflammation in the heart.

Blood tests: Blood tests may be conducted to check for markers of inflammation or autoimmune diseases.

Treatment

Managing cardiac sarcoidosis typically involves a combination of treatments aimed at controlling inflammation, managing symptoms, and preventing complications. The treatment plan may include:

Corticosteroids: Prednisone is often the first-line treatment to reduce inflammation. However, long-term use of steroids may have side effects, so careful monitoring is essential.

Immunosuppressive medications: If corticosteroids are ineffective or produce undesirable side effects, other immunosuppressive drugs like methotrexate or azathioprine may be prescribed.

Antiarrhythmic medications: Medications such as beta-blockers and anti-arrhythmic drugs can help manage irregular heart rhythms [6].

Cardiac device implantation: In some cases, a pacemaker or implantable cardioverter-defibrillator (ICD) may be recommended to control arrhythmias and protect against sudden cardiac arrest.

Heart transplant: For individuals with severe heart failure or those who do not respond to other treatments, a heart transplant may be considered.

Regular monitoring: Ongoing monitoring through imaging, EKGs, and clinical evaluations is vital to assess the disease's progression and treatment effectiveness [7].

Etiology and risk factors

The exact cause of sarcoidosis, including its cardiac manifestation, remains unknown. However, some factors may increase the risk of developing cardiac sarcoidosis:

Genetics: There may be a genetic predisposition to sarcoidosis, as it appears to run in some families.

Ethnicity: Certain ethnic groups, such as African Americans and individuals of Northern European descent, are more prone to developing sarcoidosis.

Environmental triggers: Some environmental factors, such as exposure to certain allergens or toxins, may contribute to the development of sarcoidosis in susceptible individuals.

Complications

Cardiac sarcoidosis can lead to various complications, including:

Heart failure: The inflammation and scarring in the heart can weaken the muscle, leading to heart failure, a condition where the heart can't pump blood effectively.

Arrhythmias: Irregular heart rhythms can be life-threatening, increasing the risk of sudden cardiac arrest.

Blood clots: Individuals with cardiac sarcoidosis may have an increased risk of developing blood clots, which can lead to strokes or pulmonary embolisms.

Valve problems: Inflammation can affect heart valves, causing regurgitation (leaking) or stenosis (narrowing).

Prognosis

The prognosis for cardiac sarcoidosis varies depending on several factors, including the extent of cardiac involvement and the response to treatment. Early diagnosis and prompt initiation of treatment can significantly improve outcomes. With proper management, many individuals with cardiac sarcoidosis can lead a relatively normal life.

Multidisciplinary care

Managing cardiac sarcoidosis often requires a multidisciplinary approach involving various healthcare professionals, including cardiologists, pulmonologists, rheumatologists, and electrophysiologists. Coordinated care is essential to address the complexities of the disease and its impact on multiple organ systems [8].

Lifestyle modifications

In addition to medical treatment, individuals with cardiac sarcoidosis may benefit from lifestyle modifications:

Diet: A heart-healthy diet low in sodium can help manage fluid retention and reduce strain on the heart.

Exercise: Regular, moderate exercise can improve heart function and overall well-being, but it should be done under the guidance of a healthcare provider.

Stress management: Stress can exacerbate heart symptoms. Techniques like relaxation exercises and meditation may be helpful.

Smoking cessation: Smoking can worsen cardiac sarcoidosis, so quitting is essential.

Conclusion

Cardiac sarcoidosis is a rare but potentially life-threatening condition that affects the heart. Early diagnosis and appropriate treatment are crucial for managing the disease and preventing complications. If you experience symptoms like irregular heart rhythms, chest pain, or unexplained fatigue, it's essential to seek medical attention promptly. With proper care and treatment, many individuals with cardiac sarcoidosis can lead fulfilling lives while managing the condition effectively.

Acknowledgment

None

Conflict of Interest

None

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