Cardiac sarcoidosis may represent the explanation of new heart problems in previously young healthy individuals or can be detected incidentally in people who have a diagnosis of sarcoidosis affecting other parts of their body.
Cardiac sarcoidosis may be benign, but sometimes it can be serious or even life-threatening. Cardiac involvement is a major cause of mortality in patients with sarcoidosis.
When to consider cardiac sarcoidosis
Clinicians should consider the possibility of cardiac sarcoidosis in an otherwise healthy young or middle-aged person with new onset of cardiac symptoms, in particular, heart block or arrhythmias of unexplained aetiology. In addition, this diagnosis may be present in any patient with known sarcoidosis who has an abnormal ECG or echocardiogram.
The most common cardiac symptoms include:
- shortness of breath
- palpitations: irregular heartbeats that can be described as fluttering in the chest, racing or slow heartbeats and pounding sensation in the chest
- chest pain: atypical chest pain or typical angina: dull, heavy or tight pain or discomfort in the chest with expansion sometimes to the left arm, neck, jaw or back
- fainting (syncope) or near fainting
Although cardiac involvement may be benign, this remains an important cause of sudden cardiac death in sarcoidosis. Therefore, it is essential to investigate cardiac symptoms appropriately and promptly.
Cardiac sarcoidosis is often difficult to diagnose. A biopsy of the heart is seldom performed due to the possibility of “false negative” results (the distribution of sarcoidosis is typically patchy and there is no certainty that a random biopsy will be diagnostic). Biopsies also carry the risk of complications.
Accurate diagnosis depends on the use of advanced, non-invasive, imaging modalities such as cardiac MRI and FDG PET/CT.
Our multidisciplinary team will assess each patient and select the most appropriate investigations in our dedicated cardiac sarcoidosis clinics.
We are committed to providing the highest level of clinical care through leading specialists with access to the latest advanced imaging techniques.
What to expect in the cardiac sarcoidosis clinic
Patients are seen by leading experts in the field of sarcoidosis (a chest physician and cardiologist) who will review their medical history and tests results. Our clinicians will then suggest the best management plan and follow-up.
A comprehensive respiratory and cardiac assessment is performed with:
- A clinical assessment in our day case unit.
- An initial selection of appropriate respiratory and cardiac investigations:
- Blood tests - including serum electrolytes and B-type natriuretic peptide
- Chest CT scans (unless performed recently)
- Lung function tests
- Electrocardiogram (an instantaneous record of your heart's electrical activity that tells us if there are any problems with your heart's rhythm)
- Echocardiogram (an ultrasound of the heart chambers and valves)
- 24-hour ECG (Holter) monitoring test
- Cardiac MRI
- If there are suggestive features of cardiac sarcoidosis, an FDG-PET/CT scan is performed. This state-of-the-art test is highly sensitive in detecting cardiac inflammation.
- The tests, once completed, being reviewed by our multidisciplinary team and the results and management plan are discussed with the patient. Emphasis is placed on possible side-effects and clear advice on the monitoring of therapies, with generally needs to be undertaken locally. We believe it is essential that patients and families understand our treatment plans. Therefore, we make sure to take enough time to discuss this in detail.
We accept referrals of patients with clinically suspected or proven cardiac sarcoidosis for further evaluation and management plans.
If you need to refer a patient to us, please send your referral letter to any member of the clinical team listed below. Please do not send any patient identifiable information via email.
Experts in cardiac sarcoidosis
Our team of experienced chest physicians and cardiologists are experts in the field of sarcoidosis and provide a comprehensive, multi-disciplinary approach, using advanced imaging tests to diagnose cardiac sarcoidosis.
- Professor Athol Wells, head of the interstitial lung disease unit
- Dr Rakesh Sharma, clinical lead for heart failure
- Dr Paul Oldershaw, consultant in cardiology
- Dr Sanjay Prasad, clinical lead in the CMR unit
- Dr Kshama Wechalekar, consultant in nuclear medicine
- Dr Vasileios Kouranos
You can also contact the cardiac sarcoidosis clinic administrators:
Telephone: 020 7352 8121, ext 8018
Fax: 020 7351 8951
We always try and see patients as quickly as possible after they have been referred.
We can usually see clinically urgent cases within two weeks.
We are able to arrange day-case visits for patients who live far away (so all tests can be performed on the same day).