Treatment of Cardiac Sarcoidosis

Treatment is tailored to the extent and activity of cardiac involvement, symptoms, heart rhythm and heart function. Decisions should be made by a cardiologist and a sarcoidosis specialist.

Immunosuppressive treatment

Corticosteroids are usually the first-line treatment when there is active myocardial inflammation, clinically important arrhythmia or impaired heart function. The dose is gradually reduced according to symptoms, imaging and laboratory results. Steroid-sparing medicines such as methotrexate, azathioprine or mycophenolate may be added when prolonged treatment is needed or side effects occur.

Treatment response is monitored with symptoms, ECG or Holter monitoring, echocardiography, cardiac MRI or FDG-PET, and blood tests such as troponin, BNP and inflammatory markers.

Treatment of rhythm disturbances

People with dangerous ventricular arrhythmias, significant conduction disease or a high risk of sudden cardiac death may need an implantable cardioverter-defibrillator (ICD). Pacemakers may be required for advanced heart block. Anti-arrhythmic medicines and catheter ablation are considered by the electrophysiology team when appropriate.

Heart failure care

Heart-failure treatment may include medicines that reduce the workload on the heart, diuretics for fluid retention and careful management of blood pressure. Severe cases may require specialised heart-failure services.

Follow-up

Cardiac sarcoidosis can relapse, so long-term follow-up is important even when symptoms improve. Seek urgent medical help for fainting, new chest pain, severe breathlessness or sustained palpitations. Never start, stop or change treatment without medical advice.