scholarly journals Cardiac Sarcoidosis Presenting as Constrictive Pericarditis

2014 ◽  
Vol 41 (3) ◽  
pp. 319-323 ◽  
Author(s):  
Saba Darda ◽  
Marcel E. Zughaib ◽  
Patrick B. Alexander ◽  
Christian E. Machado ◽  
Shukri W. David ◽  
...  
Keyword(s):  
Heart Failure ◽  
Pleural Effusion ◽  
Constrictive Pericarditis ◽  
Ventricular Arrhythmias ◽  
Cardiac Sarcoidosis ◽  
Clinical Course ◽  
Good Condition ◽  
Conduction Disturbances ◽  
Pathologic Findings ◽  
Recurrent Pleural Effusion

In patients with cardiac sarcoidosis, the sarcoid granulomas usually involve the myocardium or endocardium. The disease typically presents as heart failure with ventricular arrhythmias, conduction disturbances, or both. Constrictive pericarditis has rarely been described in patients with sarcoidosis: we found only 2 reports of this association. We report the case of a 57-year-old man who presented with clinical and hemodynamic features of constrictive pericarditis, of unclear cause. He was admitted for treatment of recurrent pleural effusion. After a complicated hospital course, he underwent pericardiectomy. His clinical and hemodynamic conditions improved substantially, and he was discharged from the hospital in good condition. The pathologic findings, the patient's clinical course, and his response to pericardiectomy led to our diagnosis of cardiac sarcoidosis presenting as constrictive pericarditis. In addition to the patient's case, we discuss the nature and diagnostic challenges of cardiac sarcoidosis. Increased awareness of this disease is necessary for its early detection, appropriate management, and potential cure.

scholarly journals Clinical phenotypes of cardiac sarcoidosis by latent class analysis

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
Q Dai ◽  
B Bose ◽  
P Li ◽  
B Liu ◽  
L Jin ◽  
...  
Keyword(s):  
Heart Failure ◽  
Latent Class Analysis ◽  
Clinical Outcomes ◽  
Ventricular Arrhythmias ◽  
Latent Class ◽  
Cardiac Sarcoidosis ◽  
Information Criterion ◽  
Cardiometabolic Syndrome ◽  
Study Population ◽  
Myocardial Involvement

Abstract Background Sarcoidosis is a systemic granulomatous disease with cardiac involvement reported in 20–27% of patients [1]. Cardiac sarcoidosis (CS) can lead to atrial or ventricular arrhythmias, various conduction system disorders, heart failure or sudden cardiac death, depending on the location of myocardial involvement [2]. Previous studies have investigated the possible types of CS based on the distribution of myocardial involvement on imaging as well as the role of genetic factors [3,4]. However, there are no studies describing the clinical heterogeneity of CS patients. Purpose In order to determine if clinical clusters exist in CS, we carried out a latent class analysis (LCA) to explore potential phenotypes in a large sample of CS patients from the National Inpatient Sample (NIS). Methods We identified 848 patients with a diagnosis of CS from the NIS in 2016–2018. A LCA was performed based on comorbidities. Utilizing the Bayesian information criterion and Akaike's information criterion we divided our study population into 3 cohorts. We subsequently applied the LCA model for our study population to fit each patient into one of the 3 cohorts. Finally, we compared the clinical outcomes among the 3 groups. Results Following LCA, patients in cohort 3 were strongly associated with a cardiometabolic syndrome profile with the highest prevalence of congestive heart failure (CHF, 95.1%), chronic kidney disease (CKD, 69.7%), diabetes mellitus (68.9%), hyperlipidemia (52.5%) and obesity (45.1%). Patients in cohort 2 had an intermediate prevalence of cardiometabolic syndrome with a universal diagnosis of hypertension (100%) but with the lowest number of CHF (32.5%) patients and none with CKD. Finally, patients in cohort 1 had the least comorbidities in comparison to the other groups but there was a higher prevalence of CHF (71.7%). There was no significant difference in mortality among the 3 groups, but acute respiratory failure was the highest in cohort 3. However, ventricular arrhythmias were more prevalent in cohort 1 patients (Table). Conclusion We identified 3 different types of CS based on their clinical phenotype. The clinical outcomes varied among the cohorts with ventricular arrhythmias being the most prevalent in patients with the least cardiometabolic comorbidities. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals PATIENT CHARACTERISTICS ASSOCIATED WITH VENTRICULAR ARRHYTHMIAS, HEART BLOCK, AND HEART FAILURE IN CARDIAC SARCOIDOSIS PATIENTS

CHEST Journal ◽  
2020 ◽  
Vol 158 (4) ◽  
pp. A131-A132
Author(s):  
Matthew Bocchese ◽  
David Rosenthal ◽  
Abdullah Haddad ◽  
Benjamin Rosenfeld ◽  
Crystal Chen ◽  
...  
Keyword(s):  
Heart Failure ◽  
Heart Block ◽  
Ventricular Arrhythmias ◽  
Cardiac Sarcoidosis ◽  
Patient Characteristics

Abstract 15578: Propionibacterium Acnes -associated Cardiac Sarcoidosis Presenting as Constrictive Pericarditis

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Marysa Leya ◽  
Ike Okwuosa ◽  
Jon W Lomasney ◽  
Vera H Rigolin ◽  
Amit Pawale ◽  
...  
Keyword(s):  
Heart Failure ◽  
Constrictive Pericarditis ◽  
Propionibacterium Acnes ◽  
Cardiac Sarcoidosis ◽  
Volume Overload ◽  
Pericardial Fluid ◽  
Heart Catheterization ◽  
Rare Presentation ◽  
Exertional Dyspnea ◽  
Reduced Ejection Fraction

Sarcoidosis is an antigen-mediated chronic multisystem inflammatory disease characterized by the formation of non-caseating epithelioid granulomas that disrupt tissue architecture, trigger fibrosis, and precipitate organ dysfunction. Cardiac involvement portends a poorer prognosis, presenting with conduction disease, heart failure, pulmonary hypertension, valvular disease, pericardial effusions, tamponade, ventricular arrhythmias, and sudden death. A 75-year-old man with a history of heart failure with mildly reduced ejection fraction, suspected ocular sarcoidosis, monoclonal gammopathy of uncertain significance and 6 months of exertional dyspnea and lower extremity edema presented with acute-on-chronic volume overload. His labs were notable for elevated inflammatory markers. Cardiac MRI showed pericardial thickening, complex pericardial fluid. The differential diagnosis included tamponade, restrictive cardiomyopathy or constrictive pericarditis secondary to paraproteinemia, viral/idiopathic, vasculitis, tuberculosis, lupus, or sarcoidosis. Simultaneous right and left heart catheterization was consistent with constriction. The patient underwent surgical pericardiectomy. The pathology was consistent with sarcoidosis and intraoperative cultures grew Propionibacterium acnes. This case reviews the mechanism and diagnosis of sarcoidosis, the diagnosis of constrictive pericarditis, and a possible role for P. acnes in the development of sarcoidosis. Constrictive pericarditis is a rare presentation of cardiac sarcoidosis, particularly when the only other suspected involvement of sarcoidosis is uveitis. P. acnes has been associated with granuloma formation in sarcoid, although the mechanism is still unknown. P. acnes may represent a potential therapeutic target once a mechanism is further elucidated.

scholarly journals Management of Cardiac Sarcoidosis in 2020

2020 ◽  
Vol 9 (4) ◽  
pp. 182-188
Author(s):  
Nisha Gilotra ◽  
David Okada ◽  
Apurva Sharma ◽  
Jonathan Chrispin
Keyword(s):  
Heart Failure ◽  
Heart Block ◽  
Ventricular Arrhythmias ◽  
Cardiac Involvement ◽  
Cardiac Sarcoidosis ◽  
Management Strategies ◽  
Clinical Manifestations ◽  
Future Directions ◽  
Inflammatory Phase

Sarcoidosis is an inflammatory granulomatous disease that can affect any organ. Up to one-quarter of patients with systemic sarcoidosis may have evidence of cardiac involvement. The clinical manifestations of cardiac sarcoidosis (CS) include heart block, atrial arrhythmias, ventricular arrhythmias and heart failure. The diagnosis of CS can be challenging given the patchy infiltration of the myocardium but, with the increased availability of advanced cardiac imaging, more cases of CS are being identified. Immunosuppression with corticosteroids remains the standard therapy for the acute inflammatory phase of CS, but there is an evolving role of steroid-sparing agents. In this article, the authors provide an update on the diagnosis of CS, including the role of imaging; review the clinical manifestations of CS, namely heart block, atrial and ventricular arrhythmias and heart failure; discuss updated management strategies, including immunosuppression, electrophysiological and heart failure therapies; and identify the current gaps in knowledge and future directions for cardiac sarcoidosis.

scholarly journals An Experimental Model for Myocarditis and Congestive Heart Failure after Rabbit Coronavirus Infection

1992 ◽  
Vol 165 (1) ◽  
pp. 134-140 ◽  
Author(s):  
Suzanne Edwards ◽  
J. David Small ◽  
Joachim Dieter Geratz ◽  
Lorraine K. Alexander ◽  
Ralph S. Baric
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Body Weight ◽  
Pleural Effusion ◽  
Left Ventricle ◽  
Heart Weight ◽  
Interstitial Edema ◽  
Pathologic Findings ◽  
Coronavirus Infection ◽  
The Right

Abstract In a model for virus-induced myocarditis and congestive heart failure, rabbit coronavirus infection was divided into acute (days 2–5) and subacute (days 6–12) phases on the basis of day of death and pathologic findings. During the acute phase, the principal histologic lesions were degeneration and necrosis of myocytes, myocytolysis, interstitial edema, and hemorrhage. The severity of these changes increased in the subacute phase. Pleural effusion and congestion of the lungs and liver were also present at this time. Myocarditis was detected by day 9 and peaked by day 12. Heart weights and heart weight-to-body weight ratios were increased, and dilation of the right ventricular cavity became prominent early in infection and persisted. In contrast, dilation of the left ventricle occurred late in the subacute stage. Virus was isolated from infected hearts between days 2 and 12. These data suggest that rabbit coronavirus infection progresses to myocarditis and congestive heart failure.

Right-Sided Heart Failure and Extracorporeal Life Support in Patients Undergoing Pericardiectomy for Constrictive Pericarditis: A Risk Factor Analysis for Adverse Outcome

2016 ◽  
Vol 65 (08) ◽  
pp. 662-670 ◽  
Author(s):  
Issam Ismail ◽  
Serghei Cebotari ◽  
Alexander Busse ◽  
Andreas Martens ◽  
Malakh Shrestha ◽  
...  
Keyword(s):  
Heart Failure ◽  
Pleural Effusion ◽  
Cardiac Index ◽  
Right Ventricular ◽  
Constrictive Pericarditis ◽  
Life Support ◽  
Low Voltage ◽  
Early Mortality ◽  
Right Ventricular Failure ◽  
Ventricular Failure

Background Right ventricular failure is a life-threatening postoperative complication after pericardiectomy. We conducted a retrospective study with a special emphasis on right ventricular failure. Methods Between June 1997 and September 2011, 69 patients underwent surgical pericardiectomy at our center. Mean age was 59 ( ±  15.5) years, and 49 (71%) patients were male. Causes of constrictive pericarditis included idiopathic (52%, n = 36), tuberculosis (9%, n = 6), postcardiotomy (12%, n = 8), radiation (4%, n = 3), renal insufficiency (12%, n = 8), and autoimmune disease (12%, n = 8). Concomitant cardiac surgery was performed in 33 (48%) patients. Results In-hospital mortality rate was 14% (10/69 patients). Extracorporeal membrane oxygenation (ECMO) was necessary in 8 (12%) cases because of right (n = 7) or biventricular (n = 1) failure. Statistical analysis showed a significant correlation between early mortality and the following preoperative variables: postcardiotomy (p = 0.049), radiation (p = 0.009), pleural effusion (p = 0.012), ascites (p = 0.039), hepatic congestion (p = 0.023), absence of calcification on X-ray (p = 0.041), tricuspid valve insufficiency (TI, p < 0.001), and low cardiac index (p = 0.003). Diuretic usage (p = 0.044), peripheral edema (p = 0.050), low voltage (p = 0.027), dip-plateau sign (p = 0.027), elevated GGT (p < 0.001), and decreased serum protein (p < 0.001) correlated with ECMO implantation. Binary logistic regression identified pleural effusion (OR = 16.2, 95% CI = 1.4–191.5), moderate/severe TI (OR = 28.8, 95% CI = 2.7–306.8) and low cardiac index (OR = 25.3, 95% CI = 2.0–315.6) as preoperative independent risk factors for early mortality, whereas elevated GGT (OR = 28.3, 95% CI = 2.4–329.2) and decreased protein (OR = 24.7, 95% CI = 1.8–343.7) could predict right ventricular failure with the need for ECMO. Conclusion We recommend nondelayed ECMO support in case of significant postoperative right-sided heart failure. High-risk patients might benefit from elective pre- or intraoperative ECMO implantation.

Symptomatic Heart Failure Is an Uncommon Presentation of Cardiac Sarcoidosis and Is Associated With a Higher Rate of Ventricular Arrhythmias

2010 ◽  
Vol 16 (8) ◽  
pp. S61 ◽  
Author(s):  
Matthew D. Olson ◽  
Matthew M. Zipse ◽  
Joseph L. Schuller ◽  
Diego F. Belardi ◽  
Royce L. Bargas ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ventricular Arrhythmias ◽  
Cardiac Sarcoidosis ◽  
Symptomatic Heart Failure ◽  
Uncommon Presentation

scholarly journals Investigating a Case of Recurrent Pleural Effusion

2011 ◽  
Vol 2011 ◽  
pp. 1-3
Author(s):  
Patrícia Rodrigues ◽  
Maria Neves ◽  
João Pedro Ferreira ◽  
Miguel Araújo Abreu ◽  
Fernanda Almeida
Keyword(s):  
Pleural Effusion ◽  
Medical History ◽  
Constrictive Pericarditis ◽  
Past Medical History ◽  
Pleural Effusions ◽  
Axial Tomography ◽  
The Past ◽  
Computerized Axial Tomography ◽  
Recurrent Pleural Effusion ◽  
Respiratory Complaints

We describe the case of a patient with long-standing Parkinson's disease and recurrent bilateral pleural effusions. The pleural fluid was an exudate, rich in normal lymphocytes, and the echocardiogram, chest computerized axial tomography, and immunological, microbiological and cytological studies were negative. The patient had been taking bromocriptine, which can be related to chronic pleural effusions. Using Pubmed, we found about 40 cases of pleuropulmonary changes or constrictive pericarditis that were related to bromocriptine. We decided to suspend this drug, with resolution of the pleural effusion and respiratory complaints for more than a year now. We discuss possible underlining mechanisms for this and emphasize the importance of collecting the past medical history and medication and of considering possible iatrogenic effects.

scholarly journals Cardiac sarcoidosis: Case report and review of the literature

Pneumologia ◽  
2021 ◽  
Vol 69 (3) ◽  
pp. 190-194
Author(s):  
Cristina Manuela Tirziu ◽  
Vlad-Cristian Zeca ◽  
Razvan Cristian Tirziu
Keyword(s):  
Heart Failure ◽  
Cardiac Involvement ◽  
Cardiac Sarcoidosis ◽  
Pulmonary Sarcoidosis ◽  
Young Female ◽  
High Heart Rate ◽  
Review Of The Literature ◽  
Multisystem Disease ◽  
Conduction Disturbances ◽  
Organ Dysfunctions

Abstract Sarcoidosis is a rare inflammatory multisystem disease, frequently underdiagnosed and often clinically silent, with a negative prognosis on patient’s survival should the cardiovascular system be involved. This occurs not only due to the direct involvement of the heart and blood vessels but also due to associated organ dysfunctions, most commonly pulmonary sarcoidosis. Cardiac sarcoidosis typically manifests as either conduction disturbances or, less commonly, as tachy- or bradyarrhythmia, sometimes even with signs and/or symptoms of heart failure. In this article, we present the case of a relatively young female patient with few significant comorbidities, who presented to the emergency department for palpitations with a high heart rate, which ultimately turned out to be caused by sustained ventricular tachycardia. The diagnostic steps undertaken thereafter reveal an underlying pulmonary sarcoidosis with cardiac involvement.

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