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Myocarditis
Published in Andreas P. Kalogeropoulos, Hal A. Skopicki, Javed Butler, Heart Failure, 2023
George Lazaros, Emilia Lazarou, Dimitris Tousoulis
Specific etiologies of myocarditis require pertinent therapies. Systemic autoimmune disorders (lupus, rheumatoid arthritis) will benefit from steroid or biological treatments. Corticosteroids in cardiac sarcoidosis prevent HF, although benefits have been reported even in advanced heart disease.4 Most experts recommend a broader use of cardioverter defibrillators for primary prevention of sudden cardiac death in cardiac sarcoidosis.64 Antiparasitic (benznidazole or nifurtimox) treatment for 60–90 days should be offered in Chagas disease and antibiotics in Lyme disease (oral amoxicillin or doxycycline for 14–21 days in mild-to-moderate disease and intravenous ceftriaxone, cefotaxime, or penicillin G in severe disease for 14 to 28 days).32,33
Myocarditis
Published in Mary N. Sheppard, Practical Cardiovascular Pathology, 2022
Cardiac sarcoidosis can have a variety of manifestations including conduction disease, congestive heart failure, valvular heart disease, pericardial effusions, tamponade, ventricular arrhythmias and sudden cardiac death.22 Despite this, the diagnosis of cardiac sarcoidosis remains difficult and no single diagnostic test has emerged that combines a high degree of sensitivity and specificity. Yet, commonly used clinical criteria require the diagnosis of extracardiac disease in order to establish the diagnosis of CS in the absence of EMB. Advanced cardiac imaging techniques including late gadolinium enhancement (LGE) by CMR and myocardial inflammation by 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) are extensively used now and track response to treatment of cardiac sarcoidosis. Like giant cell myocarditis, patients with cardiac sarcoidosis may benefit from pulse steroids alone or with a second immunosuppressive agent such as methotrexate or tumour necrosis factor alpha inhibitors once stabilized. Despite several decades of corticosteroid treatment for patients with CS, no randomized trial exists to establish a definitive role and experts still debate the benefits versus harm as well as the optimal dosing and duration for therapy. Even though heart block may improve with anti-inflammatory therapy, the disease course is not predictable; thus, pacemaker implantation is recommended regardless of the possibility of transient AV nodal recovery.
Cardiovascular PET-CT
Published in Yi-Hwa Liu, Albert J. Sinusas, Hybrid Imaging in Cardiovascular Medicine, 2017
Etienne Croteau, Ran Klein, Jennifer M. Renaud, Manuja Premaratne, Robert A. Dekemp
Cardiac sarcoidosis (CS) is an inflammatory condition characterized by the development of noncaseating granulomatous lesions within the affected organs. While lung involvement is the most frequent finding, cardiac involvement is increasingly being recognized and is associated with significant morbidity and mortality. Advanced imaging modalities including magnetic resonance imaging (MRI) as well as PET-CT have a significant role to play in the increasing recognition of CS, as it is a difficult diagnosis to make due to heterogeneity of patient presentation as well as the limited sensitivity of myocardial biopsy due to the patchy nature of the disease.
Comorbidities of sarcoidosis
Published in Annals of Medicine, 2022
Claudio Tana, Marjolein Drent, Hilario Nunes, Vasilis Kouranos, Francesco Cinetto, Naomi T. Jessurun, Paolo Spagnolo
In the sarcoidosis population, the development of myocardial involvement is a common cause for major cardiovascular events including major arrythmias, heart failure and even sudden cardiac death. The largest case-controlled study to date (the ACCESS [A Case Control Etiologic Study of Sarcoidosis] study) had originally reported a prevalence of 5% of cardiac sarcoidosis (CS) [75]. In the last two decades, the wider use of advanced imaging modalities [Cardiac Magnetic Resonance Imaging (CMR) and Flurodeoxyglucose Cardiac Positron Emission Imaging (FDG-PET)] as well as the increased awareness of the disease revolutionised the diagnosis and management of CS. As a result, an increased prevalence of CS has been reported over the years, which is similar to the one reported in autopsy studies [76,77].
Left atrial phasic volumes and functions changes in asymptomatic patients with sarcoidosis: evaluation by three-dimensional echocardiography
Published in Acta Cardiologica, 2022
In addition to sudden death, cardiac sarcoidosis may present with numerous forms, including heart failure, conduction blocks, valve disease due to papillary muscle dysfunction, as well as ventricular or atrial arrhythmias. The clinical features of cardiac sarcoidosis and whether or not cardiac dysfunction occurs depend on the location and extent of infiltrating sarcoid granulomas, and the amount of scarring in the heart [1]. Deterioration of atrial functions as an early sign of left ventricular dysfunction or due to inflammatory sarcoid granulomas in the atrium may indicate early cardiac involvement [1]. Post-mortem studies reported atrial involvement ranging from 6% to 12% in patients with cardiac sarcoidosis [17]. For all the reasons mentioned above, markers that suggest early cardiac involvement of sarcoidosis may contribute to the prolongation of life span and improvement of the quality of life of this patient group.
Utilization of cardiac imaging in sarcoidosis
Published in Expert Review of Cardiovascular Therapy, 2022
Mohamed Y. Elwazir, John P. Bois, Panithaya Chareonthaitawee
Cardiac sarcoidosis (CS) is an increasingly recognized disorder, usually observed as the cardiac manifestation of systemic sarcoidosis, but also frequently seen in isolation. Definitive diagnosis requires pathological evidence, but owing to the patchy nature of the disease, tissue sampling often misses the involved areas. The diagnosis is suspected based on abnormal clinical, electro-, and echocardiographic screening and is established on a probable basis using a set of criteria. Advanced imaging modalities, namely, 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG-PET/CT), and cardiac magnetic resonance (CMR), are major criteria in the two most used sets of diagnostic criteria, having shown superior diagnostic accuracy for CS. While the choice of modality is often dependent on local availability and expertise, some specific considerations may tip the balance in favor of a certain modality (Table 4). CMR appears to have an excellent negative predictive value and is the test of choice when considering potential alternative diagnoses given its ability to differentiate between various cardiomyopathies. FDG-PET, on the other hand, excels at the detection of active as opposed to quiescent or burned-out disease, and is therefore often the test of choice when immunosuppressive therapy is being considered, and to follow the response to treatment. The concomitant limited whole-body acquisition is also particularly useful for the detection of extracardiac disease, which has implications for diagnosis, prognosis, management, and localization of potential extracardiac biopsy sites.