Volume 6, Number 18;  August 16, 2006

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 Link Directly to Fulltext Article at Science Direct

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Unique Identifier [PMID]: 15458680

Authors: Bargout R. Kelly RF.

Institution: Division of Adult Cardiology, Cook County Hospital, Chicago, IL 60612, USA.

Title: Sarcoid heart disease: clinical course and treatment. [Review] [88 refs]

Source: International Journal of Cardiology. 97(2):173-82, 2004 Nov.

Abstract: Sarcoidosis is a rare granulomatous disease of unknown etiology that can affect any organ. Cardiac involvement, although uncommon, has a wide spectrum of clinical manifestations and is potentially fatal. Although there is no agreement upon a strategy for the diagnosis (which is difficult to make based on clinical information alone), the introduction of newer technology is promising and may be useful both for the early diagnosis of cardiac involvement and for the evaluation of response to therapy. Early treatment is crucial in improving symptoms and prognosis. ICD implantation and cardiac transplantation may offer improvements in management, as steroid therapy and pacemaker implantation has led to improved outcomes over the past three decades. [References: 88]

Publication Type: Journal Article. Review.

Link Directly to Fulltext Article at Publisher

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Unique Identifier [PMID]: 16002912

Authors: Smedema JP. Snoep G. van Kroonenburgh MP. van Geuns RJ. Dassen WR. Gorgels AP. Crijns HJ.

Institution: Department of Cardiology, University Hospital Maastricht, Dr Debyelaan 25, 6202 AZ Maastricht, the Netherlands. j.smedema@cardio.azm.nl

Title: Cardiac involvement in patients with pulmonary sarcoidosis assessed at two university medical centers in the Netherlands.[see comment].

Source: Chest. 128(1):30-5, 2005 Jul.

Abstract: STUDY OBJECTIVES: We aimed to determine cardiac involvement in patients with pulmonary sarcoidosis (PS) followed up at two university medical centers in the Netherlands. DESIGN: We reviewed the findings in consecutive patients assessed by our departments during 1998 to 2004, and classified them as patients who had presented with symptoms of cardiac sarcoidosis (CS) [group A], and those who had been screened for this condition (group B). SETTING: Two university medical centers in the Netherlands. PATIENTS: One hundred one patients (69 men [mean age, 47.6 years] and 32 women [mean age, 47.3 years]) with biopsy-proven PS. INTERVENTIONS: Twelve-lead ECG (n = 101), ambulatory ECG (n = 74), echocardiography (n = 80), (201)Tl single-photon emission CT (n = 61), cardiac MRI (n = 87), coronary angiography to exclude coronary artery disease (n = 17), and endomyocardial biopsy (n = 9). MEASUREMENTS: ECG, structural, and functional cardiac abnormalities according to the modified guidelines of the Japanese Ministry of Health and Welfare (1993). RESULTS: Sixteen of 19 patients in group A and 3 of 82 patients in group B received a diagnosis of CS. During a mean follow-up of 1.7 years (range, 3 months to 4 years), four patients in group A died (20%) and nine patients received a pacemaker and/or an implantable cardioverter-defibrillator (47%), while the patients in group B had an uncomplicated course. CONCLUSIONS: Once symptomatic CS develops in PS patients, the prognosis becomes very grim. In contrast, the prognosis in asymptomatic cardiac involvement in PS patients is good. Considering the poor prognosis of symptomatic CS, pulmonologists should consider regular screening of their PS patients for cardiac involvement with straightforward detection methods.

Publication Type: Journal Article. Multicenter Study.

Link Directly to Fulltext Article at Publisher

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Unique Identifier [PMID]: 709777

Authors: Silverman KJ. Hutchins GM. Bulkley BH.

Title: Cardiac sarcoid: a clinicopathologic study of 84 unselected patients with systemic sarcoidosis.

Source: Circulation. 58(6):1204-11, 1978 Dec.

Abstract: Although sarcoid may involve the myocardium, there is little information on its incidence or significance. We studied 84 consecutive autopsied patients with sarcoidosis. The patients ranged in age from 18--80 years (average 46 years) and 61% were women; 23 (27%) of them had myocardial granulomas. In eight (35%) these were clinically silent, and in 15 (65%) there was a history of heart failure and/or arrhythmias and conduction defects. Of the 23 patients, only four (17%) had grossly evident, widespread myocardial lesions: three of these four (75%) had documented arrhythmias. All four had sudden, unexpected death at an average age of 36 years; in only two had sarcoid been suspected during life. The other 19 patients (83%) had microscopically evident granulomatous involvement. Of these, eight (42%) had a thythm or conduction disturbance and three (16%) sudden death, although none of those who suffered sudden death had a recognized rhythm or conduction disturbance. Nine (15%) of those without cardiac sarcoidosis had a rhythm or conduction disturbance and eight (13%) suffered a sudden death. The results show that although myocardial involvement occurs in at least 25% of patients with sarcoid, it most often involves a small portion of myocardium and is clinically silent. Since some of the 61 patients in whom myocardial lesions were not identified may still have had small microscopic granulomas, the true incidence of myocardial sarcoid may be even greater than suggested here. Rhythm and conduction disturbances are more common in the cardiac sarcoid group, but the findings suggest that only the small subset of patients with severe, grossly evident myocardial sarcoid are at increased risk for sudden death.

Publication Type: Case Reports. Journal Article.

Resident Report / Department of Medicine & Grady Branch Library

Emory University School of Medicine

2006 Edition

Participating Faculty:  Carlos Del Rio MD  / Joyce Doyle MD / Lorenzo Difrancesco MD / Joel Mermis MD / Maunank Shah MD

Contact: Karl Woodworth