ساركويد القلب مع مظاهر مهددة للحياة: عندما لم يُحقِّق علاج الخط الثاني الموفِّر للستيرويد السيطرة على التهاب عضلة القلب

References

DOI: 10.1161/CIR.0000000000001240

For those with life-threatening manifestations such as cardiogenic shock, higher initial corticosteroid doses, including intravenous doses of methylprednisolone of up to 1000 mg/d, can be prescribed until other causes of acute myocarditis (such as giant-cell myocarditis) are excluded.

If there is evidence of ongoing inflammation on follow-up FDG-PET, then tumor necrosis factor-α–targeted therapy with infliximab or adalimumab can be considered as a third-line agent.

Tumor necrosis factor-α–targeted therapy should be used cautiously in individuals with HF with reduced ejection fraction and New York Heart Association class III to IV symptoms because prior trials investigating these agents in HF suggested potential harm in patients with HF.

The response to treatment is measured in 2 ways: (1) improvement or resolution of the clinical presentation of arrhythmias, heart block, or HF and (2) reduction in the degree of active granulomatous inflammation in the myocardium.