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Sarcoidosis

What Is The Prognosis For Cardiac Sarcoidosis?

01/05/2008

Question:

I have cardiac sarcoidosis with an AICD. For a couple of weeks my chest would hurt with heart skips. I was wearing a 30 day event monitor at the time and it showed v-tach (6 beats) that self terminated and many other atrial and ventricular (SVT) abnormalities. My prednisone was increased to 50mg a day (now on 40 split every 12 hours) and I began Methotrexate subq weekly. My heart skips better and I`m waiting to get a MUGA scan to check my EF to see if I can tolerate remicade IV monthly. I also have cardilomegaly. My last echo wasn`t able to show the EF so that is why the MUGA scan. Is it unusual to have pain with heart skips if I have sarcoidosis? It was really scary and this was the first time I had anything like this so I was surprised. I was diagnosed in 1994. What is the prognosis for cardiac sarcoidosis? No one wants to talk about this and I know it`s only a guess but I would like to be as informed as possible. Thanks so much.

Answer:

Cardiac sarcoidosis is a condition that is difficult to diagnose and is less responsive to treatment than other forms of sarcoidosis. However, as you have noticed, the "skipped heart beats" tend to improve with treatment. The challenge is to find an effective long-term treatment that has the fewest side-effects. It appears that your doctors are attempting to reduce your reliance on corticosteroids (prednisone) using alternate treatments, which is the right thing to do.

As for chest pain associated with the abnormal heart beats, that is a bit unusual. Many patients with sarcoidosis, even without heart involvement, will experience chronic chest pains. It is possible that the extra work demanded of the heart during these episodes could cause a strain on the heart that leads to chest pain, but I would talk with your heart specialist about this.

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Response by:

Elliott D Crouser, MD Elliott D Crouser, MD
Associate Professor of Pulmonary, Allergy, Critical Care & Sleep Medicine
College of Medicine
The Ohio State University