Researching for Evidence/ Sarcoidosis.
Researching for Evidence/Sarcoidosis
Sauer W, Stern B, Baughman R, Culvera D & Roya. (2017). High-Risk Sarcoidosis: Current Concepts and Research Imperatives. Annals ATS, 14(6), 437-444.
Introduction
Sarcoidosis is a condition characterized by granulomatous inflammation in any part of the body, and mostly in the lungs and lymph nodes. Cardiac sarcoidosis manifests as chest pain; fatigue; breath shortness; irregular heartbeats (arrhythmias); palpitations; fainting; and edema. This selected article provides the best guidelines for cardiac sarcoidosis.Researching for Evidence/ Sarcoidosis.
How the Findings were Obtained
The available data on patients suffering from sarcoidosis, and especially the high-risk sarcoidosis patients, was examined as a part of the National Heart, Lung, and Blood Institute’s workshop (NHLBI), in order to improve and increase knowledge regarding the symptoms and manifestations of the disease. High-risk sarcoidosis patients refer to those with presentations that require medical attention in order to prevent deteriorating disability or premature death (Sauer, Stern, Baughman, Culvera & Roya, 2017). During the NHLBI workshop, the knowledge gaps precluding in-depth and more understanding on the pathogenesis and management, and treatment of high-risk sarcoidosis were identified. In addition, evidence-based strategies recommended to address knowledge gaps to increase the understanding of manifestations of sarcoidosis and improve the care of high-risk sarcoidosis patients were identified during the NHLB workshop (Sauer et al., 2017).Researching for Evidence/ Sarcoidosis.
Description of the Best Practice
Currently, cardiac sarcoidosis is the leading cause of deaths allied to sarcoidosis. Manifestations of cardiac sarcoidosis can be fatal due to heart block or ventricular arrhythmia; this indicates the need to have an early diagnosis and treatment for cardiac sarcoidosis.
According to the workshop, the diagnosis of cardiac sarcoidosis involves the histological examination of the myocardial tissue. The occurrence of noncaseating granuloma during the histological analysis of a myocardial tissue without any other definitive cause confirms the diagnosis for sarcoidosis. Cardiac sarcoidosis is confirmed if the histological examination of endomyocardial or operative biopsy specimens indicates epithelioid granuloma devoid of caseating granuloma (Sauer et al., 2017).Researching for Evidence/ Sarcoidosis.
After confirmation of extracardiac sarcoidosis histologically, cardiac sarcoidosis is suspected when:
- The right bundle branch is completely blocked; deviation of the left axis; blockage of the atrioventricular block, contraction of ventricular prematurely; and abnormal changes on the ambulatory ECG or ECG
- Abnormal movement and thinning of the wall; dilation of the left ventricle
- Perfusion defect
- Low cardiac output, depressed ejection segment of the left ventricle; abnormal intracardiac pressure; abnormal wall motion
- Cellular infiltration/interstitial fibrosis over moderate grade (Sauer et al., 2017).
- According to the best practices, initiating immunosuppressive therapy and mostly placing an implantable cardiac defibrillator (ICD) in cardiac sarcoidosis is considered as lifesaving. The recommended management and treatment of cardiac sarcoidosis include using efficient screening techniques in patients considered asymptomatic, optimal treatment for patients manifesting cardiac sarcoidosis, and suitable use of the implanted defibrillator in order to prevent sudden death for patients presenting with cardiac sarcoidosis (Sauer et al., 2017).Researching for Evidence/ Sarcoidosis.
- According to the NHLBI’s recommendations, corticosteroids are the first-line treatments in sarcoidosis because they improve survival rate. However, corticosteroids do not lower the occurrence of ventricular arrhythmias
- Placement of an internal cardioverter‐defibrillator (ICD) is highly suggested for patients presenting with sarcoidosis and a history of ventricular tachycardia (Sauer et al., 2017).
Thoughts about the Research Findings
The research findings supported the best practice. The findings are also supported by previous studies indicating their validity and reliability. Basically, diagnosing cardiac sarcoidosis is still a challenge because a definitive diagnosis of cardiac sarcoidosis is confirmed if noncaseating granulomas are evident on endomyocardial biopsy. Screening using CMR in cardiac sarcoidosis is recommended in patients presenting with symptoms of cardiac sarcoidosis because of low diagnostic sensitivity with other diagnostic procedures (Prasse, 2016). Due to the comparatively high risk of sudden cardiac death for the patient population presenting with cardiac sarcoidosis, particularly when ventricular arrhythmias are present, prompt implantation of internal cardioverter‐defibrillator (ICD) is prioritized. For patients presenting with cardiac sarcoidosis and refractory ventricular tachyarrhythmias, and they are at high risk of sudden death, the first-line treatment is ICD together with antiarrhythmic therapy. Moreover, placement of ICD is necessary for patients presenting with and non‐sustained VT due to the high probability of VT recurring in spite of corticosteroid and antiarrhythmic treatments. This indicates that the placement of implantable cardiac defibrillator (ICD) in cardiac sarcoidosis is evidenced as a life-saving intervention.Researching for Evidence/ Sarcoidosis.