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SARKOIDOZA I SRCE

The heart can be affected by sarcoidosis in two ways. Firstly, sarcoidosis can occur in the heart muscle itself (cardiac sarcoidosis). Secondly, the heart may be indirectly affected as a result of sarcoidosis in the lungs (pulmonary hypertension). Both conditions can have serious consequences.

Informacije na ovoj stranici sastavljene su uz pomoć stručnjaka za sarkoidozu Dr. L. Williams & S. Agarwal, Kardiolozi, Dr. K. TweedRadiolog i konzultanta Dr. M. Thillai, Liječnik liječnika škrinja (sve jedinice srčane sarkoidoze, bolnica Royal Papworth) s dodatnim komentarima Dr. M. Wickremasinghe, Savjetnik liječnika za disanje i Dr. A. Varnava, Kardiolog konzultanta (i Imperial College Healthcare NHS Trust).

Sarkoidoza i Srce

The heart can be affected by sarcoidosis in two ways. Firstly, sarcoidosis can occur in the heart muscle itself (cardiac sarcoidosis). Secondly, the heart may be indirectly affected as a result of sarcoidosis in the lungs (pulmonary hypertension). Both conditions can have serious consequences.

Srčana sarkoidoza

Cardiac sarcoidosis occurs when the heart muscle itself is affected. The accumulation of immune cells causes clumps of tissue called granulomas. These can occur in the heart in different places:

• left or right ventricles and interventricular septum (wall in-between the ventricles)
• papillary muscles (connected to the heart valves)
• pericardium (thin sac lining the heart)
• cardiac conduction system (muscles regulating the heart beat)
• and less often the left or right atrium (upper chamber)

Cardiac sarcoidosis occurs in up to a third of all sarcoidosis patients, but only causes specific symptoms in around 5% of cases.

simptomi:

Symptoms of cardiac sarcoidosis include:

  • irregular heartbeat (pounding or fluttering sensation, or a ‘skipping of beats’)
  • dizziness and/or fainting spells
  • shortness of breath
  • bol u prsima
  • swelling of the legs (in later stages)

Plućna hipertenzija

Pulmonary sarcoidosis (sarcoidosis of the lungs) can also indirectly affect heart function. Abnormalities of the lungs, and of the blood vessels between the lungs and the heart, can cause an increase in the pressure within the blood vessels in the lungs (pulmonary hypertension). This pressure can then overload the right ventricle. This can occur in up to 15% of all patients with sarcoidosis.

Tehnike za razumijevanje vašeg stanja

Većina novo dijagnosticiranih pacijenata sa sarkoidozom imat će EKG, holter monitor i ehokardiogram. Pacijenti koji sumnjaju na srčanu sarkoidozu mogu imati daljnje dijagnostičke testove. Većina njih opisana je u nastavku.

EKG (elektrokardiogram):  Na taj način dobivate informacije o električnom sustavu provodljivosti srca, kao io brzini otkucaja srca i srčanog ritma. 

Echocardiogram (Echo):  To koristi ultrazvučne valove za stvaranje slika koje prikazuju pumpnu funkciju mišićnih komora srca i funkciju srčanih zalistaka. Također omogućuje mjerenje krvnog tlaka unutar srčanih žila (tražiti plućnu hipertenziju).

Magnetic Resonance Imaging (MRI):  This scan can identify involvement of sarcoidosis in the heart. Usually you will be injected with a special dye to show any changes to the soft tissue in the heart muscle. MRI images also provide information about heart function.

Nuclear Scans: Thallium scans and PET scans create images that can identify any active inflammation within the heart muscle and can help to guide treatments. For the cardiac PET scan it is important that a strict diet is kept to in the days before the scan (this will be explained to you beforehand).

Holter monitor:  A holter monitor is a small, portable ECG device that takes a continuous recording of your heart rhythm over a longer period of time (usually 24 hours but sometimes longer). It is particularly useful to identify any evidence of problems in the conduction system of the heart (e.g. very fast or slow heart beats or any abnormal rhythms).

Studije kliničke elektrofiziologije:  Kateter se koristi za mapiranje sustava provodljivosti srca. To može otkriti abnormalnosti koje mogu predisponirati abnormalno spore stope srca, kao i sve abnormalno brze ili opasne srčane ritmove koji mogu nastati iz područja upale ili ožiljka.

Right Heart Catheterisation:  Ovaj test koristi sondu za mjerenje pritisaka u srcu i obližnjim krvnim žilama kako bi se utvrdilo uključivanje plućne hipertenzije.

Biopsy of the Heart: This is rare and only used when there is a specific reason to do so. Patients who have had a lung biopsy will usually not need a heart biopsy or any further biopsies.

Blood Samples: The following may be tested:

  • angiotensin converting enzyme (ACE)
  • brain natriuretic peptide (BNP)
  • troponin

Treatment: Cardiac Sarcoidosis and Pulmonary Hypertension

Your doctor may prescribe medication to suppress the sarcoidosis:

• Corticosteroids (usually prednisolone tablets) may be used for a number of years. Some patients may require low doses longer term, in combination with other forms of immunosuppression. In severe cases intravenous steroids may be used first before switching to tablets.
• Other medicines that suppress the immune system, for example: methotrexate, mycophenolate or azathioprine.

Ovi lijekovi potiskuju upalu, ali ne liječe samo srce.

Treatment: Cardiac Sarcoidosis

Pravodobna dijagnoza i liječenje lijekovima važni su za povoljnu prognozu.

You may be prescribed the following to help regulate heart rhythm or to treat any heart failure:

• specific heart medications (tablets)
• implant a pacemaker or defibrillator (ICD)

Može se razmotriti transplantacija srca. Ovo je vrlo rijetko.

Treatment: Pulmonary Hypertension

Lijekovi mogu smanjiti simptome i poboljšati pritiske u krvnim žilama.

Može vam se propisati:

  • diuretici,
  • antagonisti endotelina,
  • prostacikline.

Može se razmotriti transplantacija pluća. Ovo je vrlo rijetko.

Page last updated: July 2019. Next review: July 2021.

Povezani sadržaji iz SarcoidosisUK:

Sarkoidoza i umor

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