1
|
Okafor J, Khattar R, Sharma R, Kouranos V. The Role of Echocardiography in the Contemporary Diagnosis and Prognosis of Cardiac Sarcoidosis: A Comprehensive Review. Life (Basel) 2023; 13:1653. [PMID: 37629510 PMCID: PMC10455750 DOI: 10.3390/life13081653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 07/23/2023] [Accepted: 07/26/2023] [Indexed: 08/27/2023] Open
Abstract
Cardiac sarcoidosis (CS) is a rare inflammatory disorder characterised by the presence of non-caseating granulomas within the myocardium. Contemporary studies have revealed that 25-30% of patients with systemic sarcoidosis have cardiac involvement, with detection rates increasing in the era of advanced cardiac imaging. The use of late gadolinium enhancement cardiac magnetic resonance and 18fluorodeoxy glucose positron emission tomography (FDG-PET) imaging has superseded endomyocardial biopsy for the diagnosis of CS. Echocardiography has historically been used as a screening tool with abnormalities triggering the need for advanced imaging, and as a tool to assess cardiac function. Regional wall thinning or aneurysm formation in a noncoronary distribution may indicate granuloma infiltration. Thinning of the basal septum in the setting of extracardiac sarcoidosis carries a high specificity for cardiac involvement. Abnormal myocardial echotexture and eccentric hypertrophy may be suggestive of active myocardial inflammation. The presence of right-ventricular involvement as indicated by free-wall aneurysms can mimic arrhythmogenic right-ventricular cardiomyopathy. More recently, the use of myocardial strain has increased the sensitivity of echocardiography in diagnosing cardiac involvement. Echocardiography is limited in prognostication, with impaired left-ventricular (LV) ejection fraction and LV dilatation being the only established independent predictors of mortality. More research is required to explore how advanced echocardiographic technologies can increase both the diagnostic sensitivity and prognostic ability of this modality in CS.
Collapse
Affiliation(s)
- Joseph Okafor
- Department of Echocardiography, Royal Brompton Hospital, London SW3 6NP, UK
- Cardiac Sarcoidosis Centre, Royal Brompton Hospital, London SW3 6NP, UK
| | - Rajdeep Khattar
- Department of Echocardiography, Royal Brompton Hospital, London SW3 6NP, UK
- Cardiac Sarcoidosis Centre, Royal Brompton Hospital, London SW3 6NP, UK
| | - Rakesh Sharma
- Cardiac Sarcoidosis Centre, Royal Brompton Hospital, London SW3 6NP, UK
| | - Vasilis Kouranos
- Cardiac Sarcoidosis Centre, Royal Brompton Hospital, London SW3 6NP, UK
| |
Collapse
|
2
|
Unger A, Unger P, Mottale R, Amzulescu M, Beun AJ. Sarcoidosis presenting as acute pericarditis. A case report and review of pericardial sarcoidosis. Acta Cardiol 2022; 77:676-682. [PMID: 34612159 DOI: 10.1080/00015385.2021.1983284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Cardiac sarcoidosis typically involves the myocardium. Pericardial effusion is uncommon, and symptomatic pericardial disease is even more infrequent. We report the case of a patient presenting with pericarditis as the first manifestation of sarcoidosis. A 50-year-old previously healthy man presented with chest pain and dyspnoea. The electrocardiogram confirmed the diagnosis of pericarditis. Computed tomography of the thorax showed pulmonary infiltrates with mediastinal and hilar adenopathies. Histological analysis of a lymph node biopsy was consistent with sarcoidosis. There was no evidence of myocardial involvement on Magnetic Resonance Imaging (MRI). We reviewed the available English literature and identified 31 cases with sarcoidosis and pericardial involvement. The majority of cases presented as pericardial effusion, which was often the first clinical manifestation of the disease. Pathological diagnosis usually occurs at extra-cardiac locations. Myocardial involvement, an important cause of morbidity and mortality, was found in 25.8% (8/31) of cases. Sarcoidosis should be considered in the differential diagnosis of patients presenting with pericardial disease. The optimal treatment regimen and long-term outcome remain largely unknown. Research in cardiac sarcoidosis should include pericardial disease as a separate manifestation in order to improve the management of this rare but likely underdiagnosed condition.
Collapse
Affiliation(s)
- Alexandre Unger
- Department of Cardiology, Université Libre de Bruxelles, Bruxelles, Belgium.,Department of Cardiology, Centre Hospitalier Universitaire (CHU) Saint-Pierre, Bruxelles, Belgium
| | - Philippe Unger
- Department of Cardiology, Université Libre de Bruxelles, Bruxelles, Belgium.,Department of Cardiology, Centre Hospitalier Universitaire (CHU) Saint-Pierre, Bruxelles, Belgium
| | - Raphaël Mottale
- Department of Cardiology, Université Libre de Bruxelles, Bruxelles, Belgium.,Department of Cardiology, Centre Hospitalier Universitaire (CHU) Saint-Pierre, Bruxelles, Belgium
| | - Mihaela Amzulescu
- Department of Cardiology, Université Libre de Bruxelles, Bruxelles, Belgium.,Department of Cardiology, Centre Hospitalier Universitaire (CHU) Saint-Pierre, Bruxelles, Belgium
| | - Abraham J Beun
- Department of Internal Medicine, Centre Hospitalier Universitaire (CHU) Saint-Pierre, Bruxelles, Belgium
| |
Collapse
|
3
|
Verdickt S, De Man F, Haine E, Van Cleemput J. Sarcoidosis presenting as cardiac tamponade: a case report. Acta Clin Belg 2021; 76:289-293. [PMID: 32000632 DOI: 10.1080/17843286.2020.1724429] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
A 62-year-old man without medical history presented with a cardiac tamponade due to a voluminous sterile hemorrhagic exudate. Hypermetabolic mediastinal lymph nodes were found on a PET-CT and pathological analysis revealed non-necrotizing granulomatous adenitis, a finding compatible with sarcoidosis. Steroids were started with rapid clinical improvement and complete resolution of the pericardial effusion.Although pericardial effusions are occasionally seen in cardiac sarcoidosis, symptomatic pericardial involvement with evolution to a tamponade is rare. Our patient is the 7th described case of a sarcoidosis presenting as a tamponade.
Collapse
Affiliation(s)
| | - Filip De Man
- Department of Cardiology, Europe Hospitals, Brussels, Belgium
| | - Emmanuel Haine
- Department of Cardiology, Europe Hospitals, Brussels, Belgium
| | - Johan Van Cleemput
- Department of Cardiology, University Hospital of Leuven, Leuven, Belgium
| |
Collapse
|
4
|
Quijano-Campos JC, Williams L, Agarwal S, Tweed K, Parker R, Lalvani A, Chiu YD, Dorey K, Devine T, Stoneman V, Toshner M, Thillai M. CASPA (CArdiac Sarcoidosis in PApworth) improving the diagnosis of cardiac involvement in patients with pulmonary sarcoidosis: protocol for a prospective observational cohort study. BMJ Open Respir Res 2020; 7:7/1/e000608. [PMID: 33037032 PMCID: PMC7549466 DOI: 10.1136/bmjresp-2020-000608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 08/22/2020] [Accepted: 09/08/2020] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Sarcoidosis is a multisystem disease, predominantly affecting the lungs but can involve the heart, resulting in cardiac sarcoidosis (CS). Patients require MRI/Positron Emission Tomography (PET) scans for diagnosis. Echocardiography, ECG and Holter monitoring may be indicative but not diagnostic alone. Patients can present late with conduction defects, heart failure or sudden death. The CASPA (CArdiac Sarcoidosis in PApworth) study protocol aims to (1) use MRI to identify CS prevalence; (2) use speckle-tracking echocardiography, signal averaged ECG and Holter monitoring to look for diagnostic pathways; and (3) identify serum proteins which may be associated with CS. METHODS AND ANALYSIS Participants with pulmonary sarcoidosis (and no known cardiac disease) from Royal Papworth Hospital will have the following: cardiac MRI with late gadolinium, two-dimensional transthoracic echocardiography with speckle tracking, signal averaged ECG and 24-hour Holter monitor. They will provide a serum sample for brain natriuretic peptide levels and proteomics by liquid chromatography coupled to high-resolution mass spectrometry. All data will be collected on OpenClinica platform and analysed approximately 6 months after final patient recruitment. ETHICS AND DISSEMINATION The Camden & Kings Cross Research Ethics Committee approved the protocol (REC number: 17/LO/0667). Integrated Research Approval System (IRAS) 222 720. Dissemination of findings will be via conference presentations and submitted to peer-reviewed journals.
Collapse
Affiliation(s)
- Juan Carlos Quijano-Campos
- Interstitial Lung Disease Unit, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK.,Research & Development, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Lynne Williams
- Department of Cardiology, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Sharad Agarwal
- Department of Cardiology, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Katharine Tweed
- Department of Radiology, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Robert Parker
- The Jenner Institute, University of Oxford, Oxford, UK
| | - Ajit Lalvani
- Faculty of Medicine, National Heart and Lung Institute, Imperial College London, London, UK
| | - Yi-Da Chiu
- Research & Development, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK.,MRC Biostatistic Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Kane Dorey
- Interstitial Lung Disease Unit, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK.,Research & Development, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Thomas Devine
- Research & Development, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Victoria Stoneman
- Research & Development, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Mark Toshner
- Pulmonary Vascular Diseases Unit, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK.,Department of Medicine, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Muhunthan Thillai
- Interstitial Lung Disease Unit, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK .,Department of Medicine, University of Cambridge School of Clinical Medicine, Cambridge, UK
| |
Collapse
|
5
|
Kudaiberdiev T, Tukusheva E, Gaibyldaev Z, Tursunbekova G, Kadyraliev Z, Akhmedova I, Tulopbergenov N, Muraliev E. Massive pericardial effusion causing cardiac tamponade accompanied by elevated CA-125 and thoracic lymphadenopathy in sarcoidosis: a case report. Int J Surg Case Rep 2020; 72:355-360. [PMID: 32563820 PMCID: PMC7306529 DOI: 10.1016/j.ijscr.2020.06.037] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/09/2020] [Accepted: 06/09/2020] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Pericardial effusion and cardiac tamponade are rare manifestations of cardiac sarcoidosis. This is a first case report that describes a patient with severe pericardial effusion and signs of cardiac tamponade with elevated carbohydrate antigen 125 (CA-125) levels, enlarged pericardial (PLN) and mediastinal lymph nodes (MLN), histologically confirmed as sarcoidosis. PRESENTATION OF CASE A 51-year-old female patient was admitted with complaints of sickness, shortness of breath on minimal exertion, swelling in lower extremities, and heaviness in right upper abdomen. Patient had diminished heart sounds, peripheral edema and hepatomegaly. She had elevated CA-125 level without gynecologic pathology. There were QRS alternation on ECG and water-bottle configuration on chest-X-ray, severe pericardial effusion, and signs of cardiac tamponade on echocardiography. CT demonstrated massive pericardial effusion, pericardial mass and enlargement of anterior MLN. The patient underwent pericardial drainage with removal of 850 mL of pericardial fluid and excision of enlarged PLN. Histological examination of PLN revealed non-caseating epithelioid cell granulomas. The diagnosis of cardiac sarcoidosis was established. Patient was discharged and 6-month follow-up was uneventful. DISCUSSION There are no reports on association of pericardial effusion, with increased CA-125 level in sarcoidosis, as we established in our patient. Our case is notable by incidental finding of enlarged PLN, mimicking pericardial mass and mediastinal lymphoadenopathy on CT, further confirmed by histological examination of PLN specimen as cardiac sarcoidosis. CONCLUSION It should be kept in mind that sarcoidosis may present as massive pericardial effusion, with signs of tamponade and pericardial lymphoadenopathy mimicking pericardial mass, mediastinal lymphoadenopathy and elevated CA-125, mimicking malignancy.
Collapse
Affiliation(s)
- Taalaibek Kudaiberdiev
- Scientific Research Institute of Heart Surgery and Organ Transplantation, Bishkek, Kyrgyzstan.
| | - Elmira Tukusheva
- Scientific Research Institute of Heart Surgery and Organ Transplantation, Bishkek, Kyrgyzstan
| | - Zhanybek Gaibyldaev
- Scientific Research Institute of Heart Surgery and Organ Transplantation, Bishkek, Kyrgyzstan
| | - Gulnaz Tursunbekova
- Scientific Research Institute of Heart Surgery and Organ Transplantation, Bishkek, Kyrgyzstan
| | - Zhunus Kadyraliev
- Scientific Research Institute of Heart Surgery and Organ Transplantation, Bishkek, Kyrgyzstan
| | - Irina Akhmedova
- Scientific Research Institute of Heart Surgery and Organ Transplantation, Bishkek, Kyrgyzstan
| | - Nurjan Tulopbergenov
- Scientific Research Institute of Heart Surgery and Organ Transplantation, Bishkek, Kyrgyzstan
| | - Emil Muraliev
- Scientific Research Institute of Heart Surgery and Organ Transplantation, Bishkek, Kyrgyzstan
| |
Collapse
|
6
|
Smedema JP, Ainslie G, Crijns HJGM. Review: Contrast-enhanced magnetic resonance in the diagnosis and management of cardiac sarcoidosis. Prog Cardiovasc Dis 2020; 63:271-307. [PMID: 32330463 DOI: 10.1016/j.pcad.2020.03.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 03/22/2020] [Indexed: 01/14/2023]
Abstract
Sarcoidosis is a relatively rare inflammatory condition which potentially carries high morbidity and substantial mortality. Due to the fact that it does not subject patients to ionizing radiation, has high temporal, spatial and contrast resolutions, cardiovascular magnetic resonance imaging (CMR) has become an important diagnostic and prognostic modality in the evaluation for cardiac involvement in this condition. This review provides relevant clinical and pathophysiological background on cardiac sarcoidosis, whilst detailing the role of CMR imaging in the diagnosis, and management of this condition.
Collapse
Affiliation(s)
| | - Gillian Ainslie
- Respiratory Clinic, Department of Medicine, Groote Schuur Hospital, Cape Town, South Africa.
| | - Harry J G M Crijns
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, the Netherlands.
| |
Collapse
|
7
|
Vasantrao SS, Mahaveer PA, Vasant SS, Vishnu SD. Pericardial sarcoidosis presenting as PUO diagnosed on FDG PET CT scan. ASIA OCEANIA JOURNAL OF NUCLEAR MEDICINE & BIOLOGY 2020; 8:74-78. [PMID: 32064287 PMCID: PMC6994781 DOI: 10.22038/aojnmb.2019.38132.1255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Pyrexia of unknown origin (PUO) is a common problem in day-to-day practice. FDG PET CT is an established investigation that aids in identifying the cause of PUO. Due to its high sensitivity PET detects an occult hypermetabolic focus in the body where CT helps in anatomical localization, vascularity, enhancement characteristics of the lesion detected on PET. It helps to differentiate benign versus malignant cause and target biopsy. Tuberculosis, lymphoma, pyelonephritis, thyroiditis appear hypermetabolic on FDG PET CT. Pericardial sarcoidosis is rare and not reported in literature as a cause of PUO. Presented here is a case of PUO secondary to pericardial granulomatosis diagnosed on PET CT. Cardiac MRI also helps in better tissue characterization and associated myocardial involvement of sarcoidosis. Histology confirmed the diagnosis of pericardial sarcoidosis in this case.
Collapse
|
8
|
Valentin R, Keeley EC, Ataya A, Gomez-Manjarres D, Petersen J, Arnaoutakis GJ, Drew P, Barnes M, Patel DC. Breaking hearts and taking names: A case of sarcoidosis related effusive-constrictive pericarditis. Respir Med 2020; 163:105879. [PMID: 32056834 DOI: 10.1016/j.rmed.2020.105879] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 12/24/2019] [Accepted: 01/17/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Pericardial involvement of sarcoidosis is a rare cause for acute heart failure, and usually occurs as a result of the development of a pericardial effusion leading to cardiac tamponade. Even rarer still, is the manifestation of constrictive pericarditis. We report a case of sarcoidosis with lung, pleural, and pericardial involvement with effusive-constrictive pericarditis leading to cardiac tamponade. CASE PRESENTATION A 34-year-old Caucasian man presented for evaluation of a history of worsening exertional dyspnea, edema, and weight loss. A high-resolution chest computed tomography showed diffuse pulmonary nodules with upper lobe predominance and in a perilymphatic distribution; large right pleural effusion; and large pericardial effusion with pericardial thickening. A transthoracic echocardiogram demonstrated early tamponade physiology for which a pericardial drain was placed. After removal of the drain he developed cardiogenic shock from cardiac tamponade attributed to the reaccumulation of a pericardial effusion and urgent pericardial window was performed. Serial echocardiography was concerning for organization and localization of the pericardial fluid. Cardiac magnetic resonance imaging demonstrated a significant reduction in pericardial slippage between the parietal and visceral layers around the heart collectively suggestive of constrictive pericarditis. Confirmation of effusive-constrictive pericarditis was noted on right heart catheterization. He then underwent pericardiectomy, which on histopathologic evaluation demonstrated non-necrotizing granulomas, thus confirming pericardial involvement of sarcoidosis. CONCLUSIONS We report a case demonstrating unique manifestations of sarcoidosis; effusive-constrictive pericarditis presenting with acute congestive heart failure.
Collapse
Affiliation(s)
- Ramon Valentin
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Ellen C Keeley
- Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Ali Ataya
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Diana Gomez-Manjarres
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Florida, Gainesville, FL, USA
| | - John Petersen
- Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville, FL, USA
| | - George J Arnaoutakis
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, FL, USA
| | - Peter Drew
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida, Gainesville, FL, USA
| | - Matt Barnes
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Divya C Patel
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Florida, Gainesville, FL, USA.
| |
Collapse
|
9
|
Abstract
Pericarditis is a common cardiac manifestation in systemic lupus erythematosus (SLE). Serositis is recognized in the ACR, SLICC, and EULAR/ACR classification criteria. We reviewed the prior research regarding the epidemiology, risk factors, presentation, and treatment of pericarditis in SLE.
Collapse
Affiliation(s)
- Eric Dein
- Rheumatology, Johns Hopkins Bayview Medical Center, Baltimore, USA
| | | | - Michelle Petri
- Rheumatology, The Johns Hopkins University School of Medicine, Baltimore, USA
| | - Genevieve Law
- Rheumatology, FETCH (For Everything That's Community Health) South Island, Victoria, CAN
| | - Homa Timlin
- Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, USA
| |
Collapse
|
10
|
Abstract
PURPOSE OF REVIEW Cardiac sarcoidosis (CS) is associated with significant morbidity and mortality. The diagnosis of CS is challenging and typically one that is only entertained after many other conditions have been ruled out. A high index of suspicion is necessary in order to correctly determine appropriate testing for the disease. Transthoracic echocardiography is the most readily available imaging modality available to help establish a diagnosis in a potential patient. However, no one echocardiographic feature is pathognomonic. RECENT FINDINGS On echocardiography, unusual wall motion abnormalities, which do not fit a classic coronary distribution, along with diastolic dysfunction may alert one to the presence of cardiac sarcoid, particularly in the right clinical context. Myocardial strain imaging on echocardiography may increase the sensitivity of identifying cardiac sarcoidosis. Alternative imaging with cardiac magnetic resonance imaging or positron emission tomography have become more frequently utilized to establish a diagnosis of CS. Cardiac sarcoidosis remains a difficult condition to diagnose. However early diagnosis is critical to decrease the associated high mortality. Endomyocardial biopsy is highly specific but lacks sensitivity due to the patchy nature of the granulomatous deposition. Thus, imaging plays a role in diagnosis as well as for follow-up. Echocardiography remains an hallmark during the workup for CS. Decreased sensitivity of echocardiography has facilitated the use of other techniques to establish the presence of CS.
Collapse
|
11
|
Ho JSY, Chilvers ER, Thillai M. Cardiac sarcoidosis - an expert review for the chest physician. Expert Rev Respir Med 2018; 13:507-520. [PMID: 30099918 DOI: 10.1080/17476348.2018.1511431] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Introduction: Sarcoidosis is a multisystem granulomatous disease predominantly affecting the lungs, with increased risk of cardiovascular disease, pulmonary hypertension and cardiac sarcoidosis (CS), the latter due to direct granuloma infiltration. Sarcoidosis is often managed by chest physicians who need to understand the diagnostic pathways and initial management plans for patients with cardiac involvement. Areas covered: The most serious consequence of CS is sudden cardiac death due to ventricular tachyarrhythmias or complete atrioventricular block. Additional complications include atrial arrhythmias and congestive cardiac failure. There are no internationally accepted screening pathways, but a combination of history, clinical examination and ECG detects up to 85% of cases. Newer modalities including signal-averaged ECG and speckle-tracking echocardiography increase identification of patients who require a definitive diagnosis. Early immunosuppression reduces the risk of conduction abnormalities and incidence of supraventricular arrhythmias. Management of ventricular arrhythmias requires antiarrhythmic medications followed by possible catheter ablation and device (ICD) implantation. Expert commentary: Prospective trials are underway to identify the optimum methods for screening, which will guide future international statements on indications for and methods of screening in CS.
Collapse
Affiliation(s)
- Jamie S Y Ho
- a Department of Medicine , University of Cambridge , Cambridge , United Kingdom
| | - Edwin R Chilvers
- a Department of Medicine , University of Cambridge , Cambridge , United Kingdom.,b Department of Respiratory Medicine , Cambridge University Hospitals , Cambridge , United Kingdom
| | - Muhunthan Thillai
- a Department of Medicine , University of Cambridge , Cambridge , United Kingdom.,c Interstitial Lung Diseases Unit , Royal Papworth Hospital , Cambridge , United Kingdom
| |
Collapse
|
12
|
|
13
|
Isobe M, Tezuka D. Isolated cardiac sarcoidosis: clinical characteristics, diagnosis and treatment. Int J Cardiol 2014; 182:132-40. [PMID: 25577749 DOI: 10.1016/j.ijcard.2014.12.056] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 11/12/2014] [Accepted: 12/21/2014] [Indexed: 02/07/2023]
Abstract
Sarcoidosis is a systemic disease characterized by the development of noncaseating epithelioid granulomas in multiple organs. Despite extensive investigations over a long period of time, the etiology of this disease remains unknown. Cardiac involvement of this disease is the most ominous complication leading to fatal outcome. Recently, attention has been focused on isolated cardiac sarcoidosis, which exists without clinically apparent sarcoidosis elsewhere. One of the critical issues of isolated cardiac sarcoidosis is difficulty in diagnosis, since existence of the cardiac lesion should be detected from cardiac manifestations alone. Because specificity of biomarkers or sensitivity of histological examination of biopsied sample is very low, diagnosis of isolated cardiac sarcoidosis mainly depends on imaging modalities. In this review article we summarized current knowledge on the pathogenesis of sarcoidosis, clinical features of cardiac sarcoidosis especially that isolated to the heart by showing some typical cases. Utilities and problems of diagnostic imaging tests for this condition including echocardiography, cardiac magnetic resonance imaging, and fluorodeoxyglucose-positron emission tomography are discussed. Advances in pharmacological and nonpharmacological treatment for cardiac sarcoidosis have improved the prognosis of cardiac sarcoidosis to a great deal; however, there are many issues that remain to be solved in the management of isolated cardiac sarcoidosis.
Collapse
Affiliation(s)
- Mitsuaki Isobe
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Japan.
| | - Daisuke Tezuka
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Japan
| |
Collapse
|