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SARKOIDOZA IN 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 tej strani so bile zbrane s pomočjo strokovnjakov sarkoidoze Dr. L. Williams & S. Agarwal, Kardiologi, K. Tweed, Radiolog in svetovalec M. ThillaiSvetovalec zdravnika prsnega koša (vse Cardoic Sarcoidosis Unit, Royal Papworth Hospital) z dodatnimi komentarji Dr. M. Wickremasinghe, Svetovalec zdravnik dihal in Dr. A. Varnava, Kardiolog svetovalca (tako Imperial College Healthcare NHS Trust).

Sarkoidoza in 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.

Srčna 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
  • bolečina v prsnem košu
  • swelling of the legs (in later stages)

Pljučna 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 razumevanje vašega stanja

Večina na novo diagnosticiranih bolnikov s sarkoidozo bo imela EKG, holter monitor in ehokardiogram. Bolniki z sumom na srčno sarkoidozo lahko dobijo nadaljnje diagnostične teste. Večina teh je opisanih v nadaljevanju.

EKG (elektrokardiogram):  To zagotavlja informacije o električnem prevodnem sistemu srca ter o srčnem utripu in srčnem ritmu. 

Echocardiogram (Echo):  To uporablja ultrazvočne valove za ustvarjanje slik, ki kažejo funkcijo črpanja mišičnih srčnih komor in funkcijo srčnih ventilov. Omogoča tudi merjenje krvnega tlaka v srčnih žilah (za iskanje pljučne hipertenzije).

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).

Klinične elektrofiziološke študije:  Za preslikavo prevodnega sistema srca se uporablja kateter. To lahko odkrije nepravilnosti, ki lahko povzročijo nenormalno počasne srčne frekvence, kot tudi nenormalno hitre ali nevarne srčne ritme, ki lahko nastanejo zaradi vnetja ali brazgotin.

Right Heart Catheterisation:  Ta test uporablja sondo za merjenje pritiskov v srcu in v bližnjih krvnih žilah za ugotavljanje pljučne 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.

Ta zdravila zavirajo vnetje, vendar ne zdravijo samega srca.

Treatment: Cardiac Sarcoidosis

Pravočasna diagnoza in zdravljenje z zdravili sta pomembna za ugodno prognozo.

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)

Lahko se razmisli o presaditvi srca. To je zelo redko.

Treatment: Pulmonary Hypertension

Zdravila lahko zmanjšajo simptome in izboljšajo pritiske v krvnih žilah.

Morda vam bodo predpisali:

  • diuretiki,
  • antagonisti endotelina,
  • prostaciklinov.

Lahko se razmisli o presaditvi pljuč. To je zelo redko.

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

Sorodne vsebine iz SarcoidosisUK:

Sarkoidoza in utrujenost

Imate utrujenost? Poiščite simptome, zdravljenje in več informacij o sarkoidozi in utrujenosti.

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