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Cardiac Sarcoidosis

Illustration of a heart next to a picture of a Cardiac Granuloma (image created with Biorender.com)

What is Sarcoidosis?

Sarcoidosis is an inflammatory disease which can affect any organ in your body, and often impacts multiple systems at once. While the most commonly affected organs are the lungs and lymph nodes, sarcoidosis can also have major impacts on your heart health. This is because sarcoidosis inflammation causes the formation of lumps of inflammation (granulomas) in your heart muscle, leading to scar tissue in your heart and affecting how well it functions.

How Cardiac Sarcoidosis Affects the Heart

Cardiac Sarcoidosis occurs in about 25% of sarcoidosis patients. While this condition is relatively rare, it can cause serious problems for your heart. Cardiac sarcoidosis inflammation causes immune cells to collect in your heart muscle and form lumps called granulomas. When these granulomas form in the muscles of your heart, they weaken the muscle and can lead to heart failure or dangerous rhythm abnormalities.

Symptoms of Cardiac Sarcoidosis

The most common symptoms of cardiac sarcoidosis are:

  • Chest pain
  • Fatigue
  • Irregular heartbeats (fast or slow arrhythmias)
  • Lightheadedness or fainting
  • Rapid or fluttering heartbeat
  • Shortness of breath
  • Swelling from excess fluid buildup

Diagnosis of Cardiac Sarcoidosis

Because sarcoidosis can affect many systems throughout your body, diagnosis is challenging. Only 5% of patients with cardiac sarcoidosis exhibit symptoms, meaning numerous tests are required for a proper diagnosis. These tests include:

  • Electrocardiogram
  • Echocardiogram
  • Holter monitor or event monitor
  • Cardiac biopsy
  • Cardiac MRI
  • Nuclear imaging, such as positron emission tomography (PET)

Treatment of Cardiac Sarcoidosis

After being diagnosed with sarcoidosis, you may work with numerous providers to monitor all of your organs which have been affected. Depending on the severity of your disorder, your cardiologist can take many different approaches to your treatment. The treatments may include:

Medications: In some cases, the impact of cardiac sarcoidosis is limited and may require no treatment. If your doctor recommends treatment, however, they may start with medication, as this is the least invasive. These medications might include immunosuppressive drugs to help reduce inflammation, or anti-arrhythmic drugs to help your heart beat normally. In rare cases, your doctor may recommend you for more invasive treatment alternatives.

Implantable Cardioverter Defibrillator (ICD): One method of treating abnormal heart rhythms due to cardiac sarcoidosis is an ICD. Alternatively, your doctor may recommend this method if they determine your arrhythmias to be severe. For the implantation of an ICD, you will be given sedation medication. Your provider will then insert wire leads into blood vessels leading to your heart. These leads will be connected to the ICD device, which is implanted under the skin. Following your procedure, this device will then send electrical impulses or a shock to your heart when you experience an arrhythmia, helping return your heart’s rhythm to normal.

Catheter Ablation: If you’re experiencing an arrhythmia, your cardiologist may also recommend a catheter ablation to improve the rhythm of your heartbeat. In this procedure, your provider will use medication to help you relax and cause you to sleep. Usually entering through an incision in your groin area, your provider will then insert catheters into the blood vessels leading to your heart. Electrodes at the ends of the catheters will then deliver energy to treat the abnormal heart rhythm, preventing the heart from contracting out of sync with the surrounding tissue.

Heart Transplant or Left Ventricular Assist Device: In the most rare and severe cases, your doctor may indicate you require a left ventricular assist device or a heart transplant. A left ventricular assist device is an implanted pump connected to an external battery pack. This device helps if your heart is too weak to properly circulate blood, increasing the amount of blood your heart pumps to the rest of your body. If your doctor determines there has been widespread damage to your heart, they may indicate you require a heart transplantation.

Cardiac Sarcoidosis Care at the Pauley Heart Center

The VCU Health Multidisciplinary Sarcoidosis Clinic brings together providers from numerous specialties in medicine. From Pauley, cardiologists like Jordana Kron, M.D., work with other providers to deliver a unique patient experience by allowing you to meet with all of your clinical specialists during one appointment. Follow the link below to read more about our sarcoidosis clinic, or to schedule an appointment.