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I've Recently Been Diagnosed With Pulmonary Sarcoidosis By A Positive
Question: I've recently been diagnosed with Pulmonary Sarcoidosis by a positive biopsy taken during a bronchoscopy. I also had to see a Cardiologist because I was having increased PVC's. I had an echocardiogram, EKG, and PET Stress test and all came back normal, so the cardiologist wasn't concerned about cardiac sarcoidosis at this point as there is not evidence of damage to my heart. He did say that, other than a cardiac biopsy, a cardiac MRI is one of the only ways to actually check for the presence of granulomas in my heart, but didn't see the need to do that right now. I also have moderate to sever anxiety disorder and OCD, and as I'm in the US and in the middle of Coronavirus outbreak here my anxiety has bee far worse and I think contributing to the increased PVC's. Normally my PVC's feel like a skipped heartbeat and a stronger heartbeat immediately after. But for the past few days I've been feeling two very close together heartbeats after the pause, not before. So a series of regular beats, a long pause, and then two very rapid beats, and then normal again. Is this a change I should be reporting to my cardiologist? Normally I would just call but we are in the height of the coronavirus outbreak in our are of the US and the doctors are very very busy. I also want to avoid going into the clinic or hospital if at all possible. Let me know what you think, thank you!
I've recently been diagnosed with Pulmonary Sarcoidosis by a positive biopsy taken during a bronchoscopy. I also had to see a Cardiologist because I was having increased PVC's. I had an echocardiogram, EKG, and PET Stress test and all came back normal, so the cardiologist wasn't concerned about cardiac sarcoidosis at this point as there is not evidence of damage to my heart. He did say that, other than a cardiac biopsy, a cardiac MRI is one of the only ways to actually check for the presence of granulomas in my heart, but didn't see the need to do that right now. I also have moderate to sever anxiety disorder and OCD, and as I'm in the US and in the middle of Coronavirus outbreak here my anxiety has bee far worse and I think contributing to the increased PVC's. Normally my PVC's feel like a skipped heartbeat and a stronger heartbeat immediately after. But for the past few days I've been feeling two very close together heartbeats after the pause, not before. So a series of regular beats, a long pause, and then two very rapid beats, and then normal again. Is this a change I should be reporting to my cardiologist? Normally I would just call but we are in the height of the coronavirus outbreak in our are of the US and the doctors are very very busy. I also want to avoid going into the clinic or hospital if at all possible. Let me know what you think, thank you!
Brief Answer:
I would explioan as follows:
Detailed Answer:
Hello!
Welcome on - Ask a Doctor - service!
I carefully reviewed your medical history and would agree with your cardiologist about cardiac sarcoidosis.
Pulmonary sarcoidosis is frequently associated with cardiac sarcoidosis.
Anyway, in the clinical practice there are also cases where the cardiac involvement is the primary location of sarcoidos.
Coming to your case, considering the fact that your cardiac ultrasound and PET scan have not revealed any obvious abnormalities, we can conclude that a potential cardiac sarcoidic involvement even if present should be not extensive.
I would agree with your cardiologist that cardiac MRI provides highly accurate information regarding the presence of sarcoid granulomas and cardiac fibrosis, which are the main substrate and trigger for cardiac arrhythmia and cardiac abnormalities.
In fact, cardiac MRI has a resolution 40-60% higher than SPECT and also a higher specificity and sensitivity than PET, which could identify even 1 gram myocardial abnormality.
Coming to this point, as you have cardiac arrhythmia symptomatology, it is necessary to quantify the amount of extrasystoles and also investigate for any complex arrhythmia, such as ventricular tachycardia runs (the fact you are feeling consecutive extra beats, raises high suspicion about the latter possibility). What I mean, regarding this issue, is the recommendation on performing an ambulatory an 24-48 hours ECG monitoring which would provide precise information regarding the amount of PVCs and the potential VTs and also if there is any cardiac conductance disturbances too.
You should discuss with your doctor on this test, when it will be possible, considering the corona virus situation.
This is not a test which is performed in the hospital, as you take away with you the device (with body surface electrodes attached). After the registration period the device is analyzed on a computer. So there is no need that you stay in contact wit the medical staff or other patients inside a medical environment.
If there is Holter evidence of a clinical important cardiac arrhythmia (quantitatively and complex ventricular arrhythmia or AV block) then a cardiac MRI should not be delayed.
Meanwhile a beta-blocker like Metoprolol 50-100 mg, or Bisoprolol 5 - 10 mg, or Atenolol 50 - 100 mg daily could be tried after the medical prescription. Other anti-arrhythmic drugs are available in case excessive arrhythmia is confirmed.
So, to conclude, what I would recommend is discussing with your attending cardiologist;first, on the possibility of performing an ambulatory Holter monitoring, second an anti-arrhythmic therapy optimization.
In this way, it would be properly guided the timing of cardiac MRi and additional therapeutic options.
You should discuss with your attending physician on the above mentioned issues and decide the right time on your medical strategy after the COVID period will be over (we aal hope as soon as possible!!!)
Meanwhile, I recommend taking herbal supplements containing valeriana, passiflora, camomile, to elp with your anxiety. Yoga and aerobics could help too. But no strenuous exercises.
Hope to have been helpful to you!
In case of any further questions, feel free to ask me again.
Kind regards,
Dr. Ilir Sharka
cardiologist
I would explioan as follows:
Detailed Answer:
Hello!
Welcome on - Ask a Doctor - service!
I carefully reviewed your medical history and would agree with your cardiologist about cardiac sarcoidosis.
Pulmonary sarcoidosis is frequently associated with cardiac sarcoidosis.
Anyway, in the clinical practice there are also cases where the cardiac involvement is the primary location of sarcoidos.
Coming to your case, considering the fact that your cardiac ultrasound and PET scan have not revealed any obvious abnormalities, we can conclude that a potential cardiac sarcoidic involvement even if present should be not extensive.
I would agree with your cardiologist that cardiac MRI provides highly accurate information regarding the presence of sarcoid granulomas and cardiac fibrosis, which are the main substrate and trigger for cardiac arrhythmia and cardiac abnormalities.
In fact, cardiac MRI has a resolution 40-60% higher than SPECT and also a higher specificity and sensitivity than PET, which could identify even 1 gram myocardial abnormality.
Coming to this point, as you have cardiac arrhythmia symptomatology, it is necessary to quantify the amount of extrasystoles and also investigate for any complex arrhythmia, such as ventricular tachycardia runs (the fact you are feeling consecutive extra beats, raises high suspicion about the latter possibility). What I mean, regarding this issue, is the recommendation on performing an ambulatory an 24-48 hours ECG monitoring which would provide precise information regarding the amount of PVCs and the potential VTs and also if there is any cardiac conductance disturbances too.
You should discuss with your doctor on this test, when it will be possible, considering the corona virus situation.
This is not a test which is performed in the hospital, as you take away with you the device (with body surface electrodes attached). After the registration period the device is analyzed on a computer. So there is no need that you stay in contact wit the medical staff or other patients inside a medical environment.
If there is Holter evidence of a clinical important cardiac arrhythmia (quantitatively and complex ventricular arrhythmia or AV block) then a cardiac MRI should not be delayed.
Meanwhile a beta-blocker like Metoprolol 50-100 mg, or Bisoprolol 5 - 10 mg, or Atenolol 50 - 100 mg daily could be tried after the medical prescription. Other anti-arrhythmic drugs are available in case excessive arrhythmia is confirmed.
So, to conclude, what I would recommend is discussing with your attending cardiologist;first, on the possibility of performing an ambulatory Holter monitoring, second an anti-arrhythmic therapy optimization.
In this way, it would be properly guided the timing of cardiac MRi and additional therapeutic options.
You should discuss with your attending physician on the above mentioned issues and decide the right time on your medical strategy after the COVID period will be over (we aal hope as soon as possible!!!)
Meanwhile, I recommend taking herbal supplements containing valeriana, passiflora, camomile, to elp with your anxiety. Yoga and aerobics could help too. But no strenuous exercises.
Hope to have been helpful to you!
In case of any further questions, feel free to ask me again.
Kind regards,
Dr. Ilir Sharka
cardiologist
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Brief Answer:
I would explioan as follows:
Detailed Answer:
Hello!
Welcome on - Ask a Doctor - service!
I carefully reviewed your medical history and would agree with your cardiologist about cardiac sarcoidosis.
Pulmonary sarcoidosis is frequently associated with cardiac sarcoidosis.
Anyway, in the clinical practice there are also cases where the cardiac involvement is the primary location of sarcoidos.
Coming to your case, considering the fact that your cardiac ultrasound and PET scan have not revealed any obvious abnormalities, we can conclude that a potential cardiac sarcoidic involvement even if present should be not extensive.
I would agree with your cardiologist that cardiac MRI provides highly accurate information regarding the presence of sarcoid granulomas and cardiac fibrosis, which are the main substrate and trigger for cardiac arrhythmia and cardiac abnormalities.
In fact, cardiac MRI has a resolution 40-60% higher than SPECT and also a higher specificity and sensitivity than PET, which could identify even 1 gram myocardial abnormality.
Coming to this point, as you have cardiac arrhythmia symptomatology, it is necessary to quantify the amount of extrasystoles and also investigate for any complex arrhythmia, such as ventricular tachycardia runs (the fact you are feeling consecutive extra beats, raises high suspicion about the latter possibility). What I mean, regarding this issue, is the recommendation on performing an ambulatory an 24-48 hours ECG monitoring which would provide precise information regarding the amount of PVCs and the potential VTs and also if there is any cardiac conductance disturbances too.
You should discuss with your doctor on this test, when it will be possible, considering the corona virus situation.
This is not a test which is performed in the hospital, as you take away with you the device (with body surface electrodes attached). After the registration period the device is analyzed on a computer. So there is no need that you stay in contact wit the medical staff or other patients inside a medical environment.
If there is Holter evidence of a clinical important cardiac arrhythmia (quantitatively and complex ventricular arrhythmia or AV block) then a cardiac MRI should not be delayed.
Meanwhile a beta-blocker like Metoprolol 50-100 mg, or Bisoprolol 5 - 10 mg, or Atenolol 50 - 100 mg daily could be tried after the medical prescription. Other anti-arrhythmic drugs are available in case excessive arrhythmia is confirmed.
So, to conclude, what I would recommend is discussing with your attending cardiologist;first, on the possibility of performing an ambulatory Holter monitoring, second an anti-arrhythmic therapy optimization.
In this way, it would be properly guided the timing of cardiac MRi and additional therapeutic options.
You should discuss with your attending physician on the above mentioned issues and decide the right time on your medical strategy after the COVID period will be over (we aal hope as soon as possible!!!)
Meanwhile, I recommend taking herbal supplements containing valeriana, passiflora, camomile, to elp with your anxiety. Yoga and aerobics could help too. But no strenuous exercises.
Hope to have been helpful to you!
In case of any further questions, feel free to ask me again.
Kind regards,
Dr. Ilir Sharka
cardiologist
I would explioan as follows:
Detailed Answer:
Hello!
Welcome on - Ask a Doctor - service!
I carefully reviewed your medical history and would agree with your cardiologist about cardiac sarcoidosis.
Pulmonary sarcoidosis is frequently associated with cardiac sarcoidosis.
Anyway, in the clinical practice there are also cases where the cardiac involvement is the primary location of sarcoidos.
Coming to your case, considering the fact that your cardiac ultrasound and PET scan have not revealed any obvious abnormalities, we can conclude that a potential cardiac sarcoidic involvement even if present should be not extensive.
I would agree with your cardiologist that cardiac MRI provides highly accurate information regarding the presence of sarcoid granulomas and cardiac fibrosis, which are the main substrate and trigger for cardiac arrhythmia and cardiac abnormalities.
In fact, cardiac MRI has a resolution 40-60% higher than SPECT and also a higher specificity and sensitivity than PET, which could identify even 1 gram myocardial abnormality.
Coming to this point, as you have cardiac arrhythmia symptomatology, it is necessary to quantify the amount of extrasystoles and also investigate for any complex arrhythmia, such as ventricular tachycardia runs (the fact you are feeling consecutive extra beats, raises high suspicion about the latter possibility). What I mean, regarding this issue, is the recommendation on performing an ambulatory an 24-48 hours ECG monitoring which would provide precise information regarding the amount of PVCs and the potential VTs and also if there is any cardiac conductance disturbances too.
You should discuss with your doctor on this test, when it will be possible, considering the corona virus situation.
This is not a test which is performed in the hospital, as you take away with you the device (with body surface electrodes attached). After the registration period the device is analyzed on a computer. So there is no need that you stay in contact wit the medical staff or other patients inside a medical environment.
If there is Holter evidence of a clinical important cardiac arrhythmia (quantitatively and complex ventricular arrhythmia or AV block) then a cardiac MRI should not be delayed.
Meanwhile a beta-blocker like Metoprolol 50-100 mg, or Bisoprolol 5 - 10 mg, or Atenolol 50 - 100 mg daily could be tried after the medical prescription. Other anti-arrhythmic drugs are available in case excessive arrhythmia is confirmed.
So, to conclude, what I would recommend is discussing with your attending cardiologist;first, on the possibility of performing an ambulatory Holter monitoring, second an anti-arrhythmic therapy optimization.
In this way, it would be properly guided the timing of cardiac MRi and additional therapeutic options.
You should discuss with your attending physician on the above mentioned issues and decide the right time on your medical strategy after the COVID period will be over (we aal hope as soon as possible!!!)
Meanwhile, I recommend taking herbal supplements containing valeriana, passiflora, camomile, to elp with your anxiety. Yoga and aerobics could help too. But no strenuous exercises.
Hope to have been helpful to you!
In case of any further questions, feel free to ask me again.
Kind regards,
Dr. Ilir Sharka
cardiologist
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
I'm not sure what you mean by consecutive extra beats. About every 20 beats I have a PVC, and then just recently it began to have two quick beats after the pause, instead of one big, hard beat. But that doesn't happen every time I have a PVC and, again, the PVC's happen about every 20 beats or so.
Do you think it safe to wait a month or so, because of coronavirus, to ask this of my doctor? Or should I call immediately? Thank you!
Do you think it safe to wait a month or so, because of coronavirus, to ask this of my doctor? Or should I call immediately? Thank you!
I'm not sure what you mean by consecutive extra beats. About every 20 beats I have a PVC, and then just recently it began to have two quick beats after the pause, instead of one big, hard beat. But that doesn't happen every time I have a PVC and, again, the PVC's happen about every 20 beats or so.
Do you think it safe to wait a month or so, because of coronavirus, to ask this of my doctor? Or should I call immediately? Thank you!
Do you think it safe to wait a month or so, because of coronavirus, to ask this of my doctor? Or should I call immediately? Thank you!
Brief Answer:
Opinion as follows:
Detailed Answer:
Hello again!
Let me explain that when discussing about cardiac arrhythmia, it is difficult to conclude on its exact appearance;
as the subjective palpitations feeling may not tell us whether there is an isolated extra-systoles or there are two consecutive extra-systoles or more.
In general after an extra-systole (PVC) there is a pause and a strong heart beat, which is in fact a normal beat (in fact we feel this normal beat and not the erratic preceding extra-systole).
If you say there were two strong beats, most likely they may have been 2 adjacent PVCs (we call them bigeminy PVCs) or two consecutive PVCs (couplets). It's difficult to differentiate only by general feeling.
But, sometimes, we may not perceive any subjective feeling when more complex arrhythmia happens (presence of 3 or more consecutive PVCs which are considered dangerous).
That's why Holter monitoring is important.
Now turning to your exact questions, I would say that up to 2-3 isolated PVCs per minute are not concerning (one PVC every 20 min), but if they get more in number (above 5-6 PVCs per minute), then you should contact your doctor and discuss on the possibility of activating the above mentioned strategy.
That's my opinion.
Hope to have been of some help!
Anyways, let me know in case of any further discussions.
Best wishes,
Dr. Iliri
Opinion as follows:
Detailed Answer:
Hello again!
Let me explain that when discussing about cardiac arrhythmia, it is difficult to conclude on its exact appearance;
as the subjective palpitations feeling may not tell us whether there is an isolated extra-systoles or there are two consecutive extra-systoles or more.
In general after an extra-systole (PVC) there is a pause and a strong heart beat, which is in fact a normal beat (in fact we feel this normal beat and not the erratic preceding extra-systole).
If you say there were two strong beats, most likely they may have been 2 adjacent PVCs (we call them bigeminy PVCs) or two consecutive PVCs (couplets). It's difficult to differentiate only by general feeling.
But, sometimes, we may not perceive any subjective feeling when more complex arrhythmia happens (presence of 3 or more consecutive PVCs which are considered dangerous).
That's why Holter monitoring is important.
Now turning to your exact questions, I would say that up to 2-3 isolated PVCs per minute are not concerning (one PVC every 20 min), but if they get more in number (above 5-6 PVCs per minute), then you should contact your doctor and discuss on the possibility of activating the above mentioned strategy.
That's my opinion.
Hope to have been of some help!
Anyways, let me know in case of any further discussions.
Best wishes,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Brief Answer:
Opinion as follows:
Detailed Answer:
Hello again!
Let me explain that when discussing about cardiac arrhythmia, it is difficult to conclude on its exact appearance;
as the subjective palpitations feeling may not tell us whether there is an isolated extra-systoles or there are two consecutive extra-systoles or more.
In general after an extra-systole (PVC) there is a pause and a strong heart beat, which is in fact a normal beat (in fact we feel this normal beat and not the erratic preceding extra-systole).
If you say there were two strong beats, most likely they may have been 2 adjacent PVCs (we call them bigeminy PVCs) or two consecutive PVCs (couplets). It's difficult to differentiate only by general feeling.
But, sometimes, we may not perceive any subjective feeling when more complex arrhythmia happens (presence of 3 or more consecutive PVCs which are considered dangerous).
That's why Holter monitoring is important.
Now turning to your exact questions, I would say that up to 2-3 isolated PVCs per minute are not concerning (one PVC every 20 min), but if they get more in number (above 5-6 PVCs per minute), then you should contact your doctor and discuss on the possibility of activating the above mentioned strategy.
That's my opinion.
Hope to have been of some help!
Anyways, let me know in case of any further discussions.
Best wishes,
Dr. Iliri
Opinion as follows:
Detailed Answer:
Hello again!
Let me explain that when discussing about cardiac arrhythmia, it is difficult to conclude on its exact appearance;
as the subjective palpitations feeling may not tell us whether there is an isolated extra-systoles or there are two consecutive extra-systoles or more.
In general after an extra-systole (PVC) there is a pause and a strong heart beat, which is in fact a normal beat (in fact we feel this normal beat and not the erratic preceding extra-systole).
If you say there were two strong beats, most likely they may have been 2 adjacent PVCs (we call them bigeminy PVCs) or two consecutive PVCs (couplets). It's difficult to differentiate only by general feeling.
But, sometimes, we may not perceive any subjective feeling when more complex arrhythmia happens (presence of 3 or more consecutive PVCs which are considered dangerous).
That's why Holter monitoring is important.
Now turning to your exact questions, I would say that up to 2-3 isolated PVCs per minute are not concerning (one PVC every 20 min), but if they get more in number (above 5-6 PVCs per minute), then you should contact your doctor and discuss on the possibility of activating the above mentioned strategy.
That's my opinion.
Hope to have been of some help!
Anyways, let me know in case of any further discussions.
Best wishes,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
I will do as you suggest. I would also mention that when I am more active during exercise and my heart rate goes up (it's about 75 resting, so when it's up in the 140's) the PVC's stop completely. And they do diminish quite a bit as well when I take Xanax for anxiety attacks. I don't know if that makes any difference as well to what you suggest.
I will do as you suggest. I would also mention that when I am more active during exercise and my heart rate goes up (it's about 75 resting, so when it's up in the 140's) the PVC's stop completely. And they do diminish quite a bit as well when I take Xanax for anxiety attacks. I don't know if that makes any difference as well to what you suggest.
Brief Answer:
I would explain as follows:
Detailed Answer:
Hello!
Explanation may be the presence of an arrhythmogenic myocardial substrate with elevated abnormal automaticity. In such case, at lower heart rate the abnormal automaticity of the arrhythmogenic focus may generate PVCs, but at higher heart rate this activity is suppressed. Anxiety may work as a triggering factor.
I recommend you to stay relaxed until this period is finished and you could contact your attending cardiologist.
Wishing you a pleasant weekend!
Kind regards,
Dr. Iliri
I would explain as follows:
Detailed Answer:
Hello!
Explanation may be the presence of an arrhythmogenic myocardial substrate with elevated abnormal automaticity. In such case, at lower heart rate the abnormal automaticity of the arrhythmogenic focus may generate PVCs, but at higher heart rate this activity is suppressed. Anxiety may work as a triggering factor.
I recommend you to stay relaxed until this period is finished and you could contact your attending cardiologist.
Wishing you a pleasant weekend!
Kind regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Brief Answer:
I would explain as follows:
Detailed Answer:
Hello!
Explanation may be the presence of an arrhythmogenic myocardial substrate with elevated abnormal automaticity. In such case, at lower heart rate the abnormal automaticity of the arrhythmogenic focus may generate PVCs, but at higher heart rate this activity is suppressed. Anxiety may work as a triggering factor.
I recommend you to stay relaxed until this period is finished and you could contact your attending cardiologist.
Wishing you a pleasant weekend!
Kind regards,
Dr. Iliri
I would explain as follows:
Detailed Answer:
Hello!
Explanation may be the presence of an arrhythmogenic myocardial substrate with elevated abnormal automaticity. In such case, at lower heart rate the abnormal automaticity of the arrhythmogenic focus may generate PVCs, but at higher heart rate this activity is suppressed. Anxiety may work as a triggering factor.
I recommend you to stay relaxed until this period is finished and you could contact your attending cardiologist.
Wishing you a pleasant weekend!
Kind regards,
Dr. Iliri
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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