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Tuesday, September 2, 2014
Sarcoid Interaction with PVCs
I am a 50 yr old male and have been diagnosed with Stage II sarcoid for about 5 years. I have been having sarcoid "flare ups" for about the last 2 years. The major indicator is that I have increased cardiac PVCs -- identified during a cardiac diagnostic test. I have a great doctor and have had nearly every heart diagnostic test. My heart is good condition (I run and maintain low weight) but my doctor believes that the sarcoid is interfering with the electrical impulses. So, when I start having noticeable PVCs, I now start taking prednisone and after about 5-6 days the PVCs stop. My doctor recommends we treat these symptoms this way. Although I have been told by a number of doctors that PVCs are not life threatening, when the sarcoid flares up, I can have up to 5-6 PVCs per minute (I can identify them by the flipping sensation in my chest and by feeling my carotid pulse). While I have faith in my doctor, I feel like I am on a spiral going nowhere in trying to eliminate the PVCs. Does this treatment sound right or are there other alternatives? I can handle the pain and fatigue with the sarcoid but the PVCs are very discomforting. Thanks
For unclear reasons sarcoidosis has an affinity for the conduction system of the heart. The natural history of heart disease caused by sarcoidosis is not well understood, but I think it is very reasonable to assume that PVCs, which are generally considered benign, could be an early indicator of sarcoidosis activation that could become more serious if left untreated.
The best management of sarcoidosis of the heart is also unclear, but corticosteroids (e.g., prednisone) act quickly and are very effective. If you find yourself using prednisone frequently and you are experiencing adverse side effects of the drug, it would be reasonable to try a steroid-sparing treatment. Steroid-sparing drugs tend to take a long time before they begin to work, and for this reason they are used long-term (to prevent reactivation of sarcoidosis). They are not good for treating "flares." Decisions relating to the use of steroid-sparing agents or intermittent prednisone really involve a dialogue between you and a doctor who is comfortable with the management of sarcoidosis involving the heart.
I hope this information is helpful.
Elliott D Crouser, MD
Associate Professor of Pulmonary, Allergy, Critical Care & Sleep Medicine
College of Medicine
The Ohio State University