Heart Failure

Cardiac Sarcoidosis

Expertise in the Care of Sarcoidosis of the Heart

Cardiac sarcoidosis is a rare disease in which tiny clusters of cells called "granulomas" grow in heart tissue. These granulomas can cause inflammation that disrupts normal heart function and may lead to heart failure. NewYork-Presbyterian's heart failure experts have a great deal of experience treating people with cardiac sarcoidosis. Our cardiologists collaborate with rheumatology, pulmonary, radiology, and electrophysiology specialists to tailor the most effective treatment plan to improve your health.

Symptoms of Cardiac Sarcoidosis

Many people with cardiac sarcoidosis have no symptoms. When symptoms do arise, they may include:

• Fatigue
• Palpitations
• Dizziness
• Fainting
• Shortness of breath
• Chest discomfort
• Leg swelling

As the inflammation in the heart gets worse, it can lead to heart failure, cardiac arrhythmias (abnormal heartbeat), atrioventricular block (heart block), and sudden cardiac death.

How We Diagnose Cardiac Sarcoidosis

One way to determine if you have cardiac sarcoidosis is through a biopsy of your heart tissue; however, this test is not very effective for finding granulomas, due to their patchy nature. As an alternative to this approach, doctors may make a diagnosis based on the presence of sarcoidosis in your other organs, your symptoms, and the results of imaging tests such as cardiac MRI and/or positron emission tomography (PET) scanning. These imaging studies can detect both active inflammation in your heart as well as scarring caused by prior inflammation.

Medical Treatment for Cardiac Sarcoidosis

There is no cure for sarcoidosis, but we try to target and reduce your heart inflammation. We begin by using corticosteroids, such as prednisone. In addition, you may take a second medication that suppresses the immune response that causes the inflammation, such as mycophenolate mofetil, methotrexate, or azathioprine. These drugs are collectively known as "steroid-sparing" agents; they may reduce inflammation without causing the side effects associated with steroids.

If you have cardiac sarcoidosis that does not respond well to those medications, monoclonal antibodies such as TNF-alpha inhibitors (infliximab, adalimumab) may be recommended. After finishing this treatment, most patients remain on some form of immunosuppressive treatment for the rest of their lives.

The Role of Pacemakers and Defibrillators for Cardiac Sarcoidosis

Cardiac sarcoidosis can cause dangerous heart rhythms. These include heart block (abnormally slow heart rhythm) or ventricular tachycardia/ventricular fibrillation (dangerously fast heart rhythms). Patients with these problems may benefit from the implantation of a cardiac pacemaker and/or implantable cardioverter defibrillator (ICD). NewYork-Presbyterian has excellent programs featuring cardiac electrophysiologists who have exceptional experience implanting these useful heart devices.

Advanced Treatments for Cardiac Sarcoidosis

If you have cardiac sarcoidosis with inflammation that is not going away or has caused scarring that is burdening your heart, you may be at risk for end-stage heart failure. Advanced heart failure therapies such as implantation of a mechanical pump called a left ventricular assist device (LVAD)—which helps your heart pump blood to the rest of your body—or heart transplantation may be necessary. NewYork-Presbyterian has pioneered both LVAD use and heart transplantation and is known around the world for our programs offering these specialized therapies.