restrictive cardiomyopathy and sarcoidosis

Dear Dr,

I have recently at the age of 57 yrs, been diagnosed with restrictive cardiomyopathy after a near collapse and a subsequent angiogram which showed that the pressures in my heart were too high. I also have a past history of sarcoidosis and cardiac involvement, over 30 yrs ago, which I thought I had recently recovered from.

At the moment I am able to work full time, but get breathless and tight in the chest if I walk too fast or climb stairs. My ECG was normal. I have been told that it progressive, but as yet I have not seen my cardiologist to tell him about my past history of sarcoidosis.

My question is - what do you think my prognosis is? Assuming I am in the early stages of heart failure (I have intermittent pitting oedema), how long do you think I will live?

[kenkeith]

Much of the time the cause of restrictive cardiomyopathy is unknown, apparently according to your post sarcoidosis (abnormal inflammation of heart tissue) is the underlying cause. The inflammation may cause the heart (the ventricles) to be abnormally rigid and lack the flexibility to expand as the ventricles fill with blood.

The  sarcoidosis can lead to irreversible scarring (fibrosis) of the tissue between the air sacs in your lungs, making it difficult to breathe.  That may be an issue as well cardiomyopathy;  The condition can cause an irregular heart rhythm (arrhythmia) and a weak heart muscle (cardiomyopathy...heart failure).

Sometimes sarcoidosis develops gradually and produces signs and symptoms that last for years. Or it may appear suddenly and then disappear just as quickly so it is difficult to assess. An abnormal EKG and chest x-ray would usually show indicate an enlarged heart...but your EKG was normal!  You should have an echo to assess the pumping function of the heart.  Your symptoms may be associated with a pulmonary issue.

No one can predict the future or prognosis of heart failure....it involves available treatment, one's constitution, etc.

[carolan777]

Thankyou for your interest and response.

I agree with you that I need an echocardiogram, and I wonder whether my normal EKG was due to the fact that I take the beta blocker propranolol for an unrelated essential tremor that I have.

During the angiogram it was established that my ejection fraction was 0.50, which I gather is the lower end of normal.

I shall know more when I see the csrdiologist, but internet sites do not paint a very rosy picture when it comes to cardiac sarcoidosis and restrictive cardiomyopathy.

[kenkeith]

False positives are more frequent than false negatives.  There are many conditions and situations that can cause electrical impulses to react inappropriately that does not relate to any heart or health condition and the agents includes medication, drugs, diet, equipment malfunction, not properly calibrated, etc.

Your ejection fraction does not indicate heart muscle damage of any consequence, and it seems that would be expected with heart related sarcoidosis!  Your symptoms and signs could be related to pulmonary issues.