Sarcoidosis is an inflammatory disease that causes small clusters of immune cells, called granulomas, to form in various organs throughout the body. While it most commonly affects the lungs and lymph nodes, these granulomas can also develop in other organs, including the heart. Understanding this specific manifestation is important due to its potential impact on heart function.
Understanding Cardiac Sarcoidosis
Cardiac sarcoidosis involves granuloma formation within the heart tissue. These immune cell collections can lead to inflammation and, over time, cause scarring, known as fibrosis, within the heart muscle. Such damage can disrupt the heart’s electrical system and its ability to pump blood effectively.
Granulomas can affect different areas of the heart, including the ventricles, which are the main pumping chambers. The left ventricle is more frequently involved, though right ventricle involvement can indicate a less favorable outlook. When inflammation and scarring occur in areas like the interventricular septum, the wall separating the heart’s lower chambers, it can interfere with the heart’s electrical conduction pathways.
Recognizing the Signs
Symptoms of cardiac sarcoidosis vary widely, from subtle to severe, and often mimic other heart conditions. Individuals might experience fatigue, shortness of breath, and heart palpitations (sensations of a rapid or irregular heartbeat). Chest pain or tightness can also be present.
Other indicators include lightheadedness or fainting spells, known as syncope. In later stages, leg swelling can occur, signaling potential heart failure. Since these symptoms are not specific to cardiac sarcoidosis, report any new or worsening cardiac concerns to a healthcare provider for proper evaluation.
Diagnosing Cardiac Sarcoidosis
Diagnosing cardiac sarcoidosis requires a comprehensive approach due to its varied and often non-specific symptoms. Initial evaluations involve an electrocardiogram (ECG) to check the heart’s electrical activity and an echocardiogram, which uses sound waves to image heart structure and function. An echocardiogram can reveal abnormalities such as wall thinning or reduced pumping ability.
Specialized imaging techniques play a significant role in confirming diagnosis. Cardiac magnetic resonance imaging (CMR) identifies scarring and changes in the heart muscle. Positron emission tomography (PET) scans detect active inflammation within the heart. While a heart biopsy can provide a definitive diagnosis by identifying granulomas, its sensitivity can be limited due to the patchy nature of the disease. Therefore, a cardiologist experienced in sarcoidosis conducts a thorough assessment, combining clinical findings with various imaging results.
Treatment and Long-Term Management
Treatment for cardiac sarcoidosis focuses on reducing inflammation, preventing further heart damage, and managing existing symptoms. Corticosteroids are a primary treatment, suppressing the immune system and decreasing inflammation. Other immunosuppressive medications, such as methotrexate or azathioprine, may be used as second-line agents, sometimes with corticosteroids, to control the disease and allow for lower steroid doses.
For individuals with heart rhythm disturbances, device implantation may be necessary. Pacemakers regulate slow heart rates or heart block, while implantable cardioverter-defibrillators (ICDs) prevent life-threatening rapid heart rhythms. Regular follow-up with a multidisciplinary care team, including cardiologists and sarcoidosis specialists, is important for monitoring heart function, adjusting medications, and addressing new complications. This ongoing management optimizes outcomes and maintains quality of life.