Cardiac Sarcoidosis

Sarcoidosis is an inflammatory disease in which clusters of immune cells called granulomas form in organs, most often the lungs and lymph nodes. Cardiac sarcoidosis means the heart muscle is involved. Inflammation and later scarring interfere with the electrical wiring and the pumping function.

It is clinically apparent in about 5 in 100 people with sarcoidosis, though scans find silent involvement more often, and it can be the first or only sign of the disease. It matters because it can cause heart block and dangerous ventricular arrhythmias in relatively young adults.

Symptoms

• Palpitations or a racing heartbeat
• Dizziness, blackouts or near-fainting
• Unexplained heart block on ECG in someone under 60
• Breathlessness, fatigue and ankle swelling from heart failure
• Chest discomfort
• Accompanying cough, skin rash, eye inflammation or swollen glands from sarcoid elsewhere
• No symptoms, with an abnormal ECG or echo found on screening

Causes and risk factors

The cause of sarcoidosis is unknown. The leading theory is an exaggerated immune response to an unidentified inhaled trigger in genetically susceptible people. It most often starts between the ages of 25 and 60 and is more common and more severe in people of African and Scandinavian descent, and cardiac involvement is reported particularly often in Japan. Granulomas favour the septum between the ventricles, which explains the frequency of conduction block.

How it is diagnosed

• ECG and Holter monitoring: Look for heart block, bundle branch block and ventricular arrhythmias.
• Echocardiography: May show thinning of the basal septum, wall motion abnormalities or reduced function; can be normal early on.
• Cardiac MRI: Shows patchy scar and inflammation in a non-coronary pattern; the key screening test.
• FDG PET scan: Performed after a special low-carbohydrate diet, it shows active inflammation and is used to monitor response to treatment.
• Biopsy: Tissue from lung, lymph node or skin is preferred. Heart biopsy often misses the patchy disease.

Treatment options

• Corticosteroids: Prednisolone is first-line for active inflammation, tapered over months under PET guidance.
• Steroid-sparing immunosuppression: Methotrexate, azathioprine, mycophenolate, or infliximab and adalimumab for resistant disease.
• Pacemaker: For high-grade heart block; many specialists choose a device with defibrillator capability.
• Implantable defibrillator (ICD): For ventricular arrhythmias, reduced ejection fraction, or significant scar with other risk markers.
• Heart failure and anti-arrhythmic medicines, and ablation: Standard heart failure therapy; catheter ablation for ventricular tachycardia that persists once inflammation is treated.
• Heart transplant: For end-stage disease in selected patients.

When it is urgent

Blackouts, sustained rapid palpitations, or palpitations with chest pain or breathlessness need emergency assessment locally. If you have sarcoidosis and develop fainting or a new slow pulse, seek same-day care, as heart block can progress quickly.

Travelling to Türkiye for treatment

A visit of 4 to 6 days can cover MRI, FDG PET with the required dietary preparation, rhythm monitoring and a multidisciplinary opinion, and a device can be implanted if indicated. Immunosuppressive treatment runs for a year or more with repeat scans and blood monitoring, so it has to be led by specialists near your home.

Send your reports, scans and a short history and a Clinic-Y coordinator replies within 24 hours with suitable teams and written, all-inclusive proposals side by side. Reviewing your case is free.

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