Dudziak Maria, Jankowska Hanna, Dorniak Karolina
Department of Noninvasive Cardiac Diagnostic, 2nd Chair of Cardiology and Electrotherapy, Medical University of Gdansk, Poland.
Pol Merkur Lekarski. 2018 Mar 27;44(261):124-129.
Sarcoidosis is a generalised granulomatous disorder of unknown aetiology. Cardiac involvement may affect conduction system, myocardium, valvular apparatus and pericardium. Clinical spectrum ranges from asymptomatic involvement to sudden cardiac death. Patients with biopsy-proven extracardiac sarcoidosis should be screened for cardiac involvement (standard ECG, 24-hour Holter ECG, echocardiography) and in case of any abnormalities found on these tests, more advanced diagnostic methods should be used. Steroid treatment is still the mainstay of therapy in cardiac sarcoidosis. Several immunosuppresive agents are also effective and used in different combinations with steroids, as well as heart failure treatment (including ACE inhibitors, angiotensin receptor blockers, beta-blockers and diuretics). Advanced heart block requires pacemaker implantation, and implantable cardioverterdefibrillator is an effective treatment in primary and secondary prophylaxis of sudden cardiac death. Heart transplantation is considered in advanced, drug-resistant heart failure or incessant ventricular arrhythmias unresponsive to other forms of therapy.
结节病是一种病因不明的全身性肉芽肿性疾病。心脏受累可能影响传导系统、心肌、瓣膜装置和心包。临床谱范围从无症状受累到心源性猝死。经活检证实有心脏外结节病的患者应筛查心脏受累情况（标准心电图、24小时动态心电图、超声心动图），如果这些检查发现任何异常，应采用更先进的诊断方法。类固醇治疗仍然是心脏结节病治疗的主要手段。几种免疫抑制剂也有效，并与类固醇联合使用，以及用于心力衰竭治疗（包括血管紧张素转换酶抑制剂、血管紧张素受体阻滞剂、β受体阻滞剂和利尿剂）。高度房室传导阻滞需要植入起搏器，植入式心脏复律除颤器是心源性猝死一级和二级预防的有效治疗方法。对于晚期、耐药性心力衰竭或对其他治疗形式无反应的持续性室性心律失常，可考虑心脏移植。
