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Sarcoidosis

How Serious Is Cardiac Sarcoidosis?

01/09/2008

Question:

I have the usual chest pains/tightness and shortness of breath due to pulmonary sarcoidosis and lymph node activity. I have also noticed a fluttering sensation in my chest that comes and goes. My assumption is my heart is palpating or fluttering. Is this the electrical affectation of Sarcoidosis on my heart and if so how serious is this? What is the best test to diagnose cardiac Sarcoidosis or diagnose lack of Cardiac Sarcoidosis involvement? All I`ve read states a Cardiac MRI is the best test.

Answer:

Cardiac involvement by sarcoidosis is a potentially serious concern. In many cases, sarcoidosis promotes abnormal heart rhythms, as you describe. The first step is to perform tests to see if you have abnormal heart beats or signs of abnormal heart function. If these tests are abnormal, further testing, such as gallium scan, perfusion scan, cardiac MRI or positron emission tomography (PET) scan would be indicated. Which test is best depends upon the skills of your local health care team.

If all of these are available, a CT scan with PET imaging may be best (that is my personal experience, but not many studies have been conducted to compare these modalities). CT/PET scan is very expensive and has to be done under carefully controlled conditions or the results will be unreliable. MRI is a bit less expensive and the resolution is also less. None of these tests can diagnose sarcoidosis, they only show signs of abnormalities in the heart that are likely to represent areas of inflammation, such as occurs in the setting of active sarcoidosis.

As you can see, this is a complicated issue that is best sorted out by the medical experts who are caring for you. Your symptoms should be taken very seriously because untreated cardiac sarcoidosis can be life-threatening.

For more information:

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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