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Patient handout

Cardiac sarcoidosis (chronic — immunosuppression + arrhythmic protection)

PRODUCTION

1. Your condition

This handout is for cardiac sarcoidosis (chronic — immunosuppression + arrhythmic protection). Your care team identified this based on: unexplained high-grade av block in adult <60 — cs until proven otherwise.

Other reasons your team may use this plan: ventricular tachycardia / palpitations of unclear cause; cmr patchy non-ischemic lge / fdg-pet focal myocardial uptake; known systemic sarcoidosis with cardiac symptoms/ecg change.

3. When to call your provider

Contact your care team if any of the following happen:

  • Complete heart block / sustained VT → EP + ICD-capable device now — 2014 HRS
  • Fulminant/rapidly progressive → consider giant-cell myocarditis, acute pathway — 2014 HRS
  • End-stage cardiomyopathy / intractable VT → transplant — 2023 ESC Cardiomyopathy

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

  • Unexplained high-grade AV block in adult <60 — CS until proven otherwise; advanced imaging (MRI/PET) BEFORE committing to a pacemaker-only device — 2014 HRS
  • Spontaneous sustained VT/VF in CS — ICD (secondary prevention) — 2014 HRS(life-threatening)
  • FDG-PET-active myocardial inflammation — corticosteroid immunosuppression to halt progression; titrate to serial PET — 2014 HRS
  • Fulminant, rapidly progressive course with VT/cardiogenic shock — consider giant-cell myocarditis (biopsy) — different urgent immunosuppression — 2014 HRS(life-threatening)
  • CS with heart pumping strength (LVEF) ≤40 — standard HFrEF 4-pillar the four foundational heart-failure medications applies (granulomatous, not amyloid-stiff) — 2022 ACC/AHA HF
  • End-stage CS cardiomyopathy or intractable VT despite therapy — transplant evaluation (good outcomes; immunosuppression continues) — 2023 ESC Cardiomyopathy(life-threatening)
  • Pregnancy with CS — immunosuppressant selection (avoid methotrexate/mycophenolate; prednisone/azathioprine relatively safer), arrhythmia + device monitoring; cardio-obstetric — ESC 2018 Pregnancy

5. Follow-up

Steroid-sparing taper, relapse surveillance, systemic-sarcoid co-management

6. Sources

Guideline: 2014 HRS Cardiac Sarcoidosis Expert Consensus + 2023 ESC Cardiomyopathy Guideline + 2022 AHA/ACC/HFSA HF Guideline

  1. pubmed.ncbi.nlm.nih.gov/24819193
  2. pubmed.ncbi.nlm.nih.gov/37622657
  3. pubmed.ncbi.nlm.nih.gov/35379504