Pregnancy and your heart: why it's important to plan ahead
Immunosuppressive Therapy For Recurrent Ventricular Arrhythmias In Cardiac Sarcoidosis
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The following is a summary of "Cardiac sarcoidosis in patients with recurrent ventricular arrhythmias refractory to endocardial ablation," published in the August 2024 issue of Cardiology by Nentwich et al.
Cardiac sarcoidosis diagnosis is challenging due to diverse symptoms and potential sampling errors in endomyocardial biopsy (EMB), but early immunosuppression can improve prognosis.
Researchers conducted a retrospective study investigating additional markers supporting the diagnosis of cardiac sarcoidosis by analyzing the single-center cohort of patients with recurrent ventricular arrhythmias (VA) and nonischemic cardiomyopathy after the failure of endocardial ablation.
They analyzed data from 135 patients (mean age 49 y, 63% male) hospitalized for epicardial VA ablation after the failure of endocardial ablation over 4 years. Of this group, 19 patients either had a previous diagnosis of cardiac sarcoidosis or were newly diagnosed. The mean follow-up time was 4.3 years. The analysis included ECG criteria, primary manifestation, histological findings in EMB, history of VT ablation, distribution of scars on MRI, electroanatomical mapping (EAM), PET CT findings, atrial tachycardias, valve disease, and comorbidities.
The results showed that 6 of 19 (32%) patients showed a right bundle block, and 6 of 19 (32%) had AV nodal disease, including 4 patients with AV-block III, 14 patients (73%) primarily presented with VA (including 3 with cardiac arrest). In all 19 patients, cardiac EMB revealed elevated CD68 macrophages and CD3 T lymphocytes; 7 of 19 were positive for granuloma (36.8%), and 6 patients (100%) undergoing PET CT showed acute inflammation. Analysis of scar distribution showed the most common locations were basal anteroseptal, basal inferoseptal, mid inferoseptal, mid inferior, and the septal RV/RVOT (septal substrate in 100%). There is a high correlation between the MRI findings and low voltage in the EAM. All patients received immunosuppressive therapy. No patient died during follow-up, and 1 patient had a high-urgent heart transplant after steroid therapy withdrawal.
Investigators concluded that chronic inflammation may be the underlying cause of unspecified cardiomyopathy and refractory VA, with septal substrate, elevated CD3 lymphocytes, and inflammation suggesting cardiac sarcoidosis, prompting consideration of immunosuppressive therapy.
Source: link.Springer.Com/article/10.1007/s00392-024-02509-z
Foundation For Sarcoidosis Research Expands Scientific Advisory Board With 14 New Experts To Enhance Sarcoidosis Research And Patient Care
CHICAGO, Aug. 28, 2024 (GLOBE NEWSWIRE) -- The Foundation for Sarcoidosis Research (FSR), the leading international organization dedicated to finding a cure for sarcoidosis and improving care for sarcoidosis patients, is pleased to announce the appointment of fourteen new members to serve the organization's Scientific Advisory Board (SAB). This brings the current SAB membership to 25 members.
The FSR SAB consists of world-renowned researchers, clinicians, and health industry leaders representing diverse professional disciplines with experience in advancing research, clinical trials, and the scientific understanding of sarcoidosis.
The FSR SAB provides guidance to the FSR Board of Directors and FSR leadership on scientific priorities and strategies, ensures FSR's educational material reflects the most up-to-date scientific knowledge, and applies experience and rigor to ensure FSR's grant funding is awarded towards the most innovative and scientifically promising research efforts.
"We are thrilled and honored to welcome these fourteen dedicated sarcoidosis experts to the SAB," said Dr. Elliot Crouser MD, Physician and Professor at the Ohio State University and SAB Chair. "We look forward to advancing the mission of FSR, and the broad expertise reflected in this expanded advisory board should prove to be quite impactful."
This panel reflects the most diverse set of expertise in FSR's 25-year history. By bringing together experts in pulmonology, genetics, rheumatology, neurology, dermatology, and cardiology, FSR hopes to foster a multi-disciplinary approach to advancing the clinical, basic, and translational research needed to improve patient outcomes.
"Our new Scientific Advisory Board members' expertise and dedication will be instrumental in advancing our mission to improve patient outcomes and advocate for innovative sarcoidosis research initiatives," said Mary McGowan, FSR Chief Executive Officer. "Their diverse perspectives will help us navigate the complexities of modern medicine and ensure that our efforts remain patient-centered and strategic."
The following new FSR SAB members begin their orientation in September 2024 with the official terms initiating in January 2025.
For more information about the Foundation for Sarcoidosis Research, and sarcoidosis research and funding opportunities, please visit www.Stopsarcoidosis.Org.
About SarcoidosisSarcoidosis is a rare inflammatory disease characterized by the formation of granulomas—tiny clumps of inflammatory cells—in one or more organs of the body. Despite increasing advances in research, sarcoidosis remains difficult to diagnose with limited treatment options and no known cure.
About the Foundation for Sarcoidosis Research (FSR)The Foundation for Sarcoidosis Research (FSR) is the leading international organization dedicated to finding a cure for sarcoidosis and improving care for sarcoidosis patients through research, education, and support. Since its establishment in 2000, FSR has fostered over $6.5 million in sarcoidosis-specific research efforts. For more information and to join our community, visit www.Stopsarcoidosis.Org.
Contact:Cathi Davis312-341-0500cathi@stopsarcoidosis.Org
A photo accompanying this announcement is available at https://www.Globenewswire.Com/NewsRoom/AttachmentNg/e3f38b1a-791f-49b6-aa7c-092ad5e370e3
The Persistent, And Rising, Threat Of Black Lung Disease
Also known as coal workers' pneumoconiosis, black lung disease (or miner's lung) is typically the result of inhaling coal dust for many years that causes scarring in the lungs and makes breathing increasingly difficult. The prevalence of black lung has been on the rise in the US.
Despite being on the decline after the 1970s, the prevalence of black lung has been on the rise over the last 2 decades,1 and the federal government has issued a new rule on miners' safety.2 With changes in mining technology, miners can dig deeper, exposing them more to silica, which is highly toxic and is driving rising rates of black lung.1
Pneumoconiosis, which encompasses the family of interstitial lung diseases—those that cause progressive scarring of lung tissue and eventually a lack of oxygen in the blood3—can result from an autoimmune condition. It can also develop after an individual has inhaled either organic or nonorganic compounds that include bird and animal droppings, cotton or other fibers, silica, asbestos, diacetyl, beryllium, and talc.3-5
Common forms of pneumoconiosis are asbestosis, silicosis, mixed-dust pneumoconiosis, and byssinosis, and they all are considered occupational lung diseases.4-7 One of the most well-known types of pneumoconiosis and potentially the best-known occupational illness in the US8—perhaps infamous—is coal workers' pneumoconiosis, also known as miner's lung and black lung disease. As its eponymous name states, this subtype of pneumoconiosis results from inhalation of coal dust and is most often seen in coal miners.7 It entails both inflammation and fibrosis of the lung tissue, and cases can be simple or complicated.6
Described as far back as the 16th century as a blue-black marbling of the lung and in the 19th century as black pigmentation and darkening of the lungs, black lung disease is most often seen in miners of hard coal but can also be found among those who work in soft-coal or graphite mines.8,9
Recent data show that per US county overall, there are 4.34 cases of black lung disease and 3.44 deaths as a direct result of it. This number indicates there are approximately 0.04 deaths per 1000 US population, and 4 deaths per 100,000 US population; for cases of black lung, 0.11 and 11, respectively. One of the most well-known areas with a high concentration of black lung disease is Appalachia, which stretches from southern New York state to northern Mississippi and all of West Virginia, comprising 423 counties; 206,000 square miles; and 26.4 million residents.10,11 Here, among those with at least 25 years of mine work, approximately 20% of coal miners have black lung disease.10,12 Further, more younger miners—those born after 1940 compared with those born in 1939 or earlier—have a higher risk of dying from this nonmalignant respiratory disease.12
Pneumoconiosis, better known as black lung disease or miner's lung, is a progressive lung condition that involves both inflammation and fibrosis of lung tissue, and can remain asymptomatic for yearsImage Credit: adam88xx-stock.Adobe.Com
While black lung disease can initially be asymptomatic, it is a progressive disease and can lead to a range of severe and debilitating symptoms that significantly impact daily life and overall quality of life. Over time, these symptoms can worsen, and they often require ongoing medical care and limit a person's ability to work or engage in physical activities.
Symptomatic cases can take years to develop,6,13,15 and there is no cure—treatment is palliative.13 Common symptoms of black lung include the following6,13,16:
There are many methods used to evaluate an individual for lung diseases that carry over into use among those with black lung disease. Principal imaging tests are chest x-rays, CT scans, and MRIs.17
A chest x-ray is a fast and painless method that involves investigating lung structures and damages to them. CT scans, also painless image, take that investigation further through the use of large amounts of detailed images (also known as slices) of both the lungs and of the chest, which then are used to form a comprehensive representation of the condition of the lungs and their structures. MRIs bring both chest x-rays and chest CT scans together by explaining what those test results may indicate. Although not painful, MRIs can be uncomfortable and very loud; they also pose a few risks for those with implanted devises and metal inside their bodies. MRIs frequently involve images first without contrast and then images with contrast.17 Essentially acting as a highlighter, a contrast is a gadolinium-based agent that helps to enhance the images taken during an MRI because it can align with the magnetic field and is harmless in injectable form; otherwise, it is a toxic rare earth metal,18 enabling the radiologist to more accurately make their diagnosis.19
Pulmonary function tests (PFTs), also known as lung function tests, are also incorporated when evaluating for black lung disease, and they are necessary if coal mine workers want to file for workers' compensation.20 Unlike imaging tests, which typically are used to diagnose, pulmonary function tests help to detect the degree of severity of the diagnosis,14 which includes total lung capacity, tidal volume, functional residual capacity, residual volume, and vital capacity—among many other indicators.21
There are 3 main types of PFTs. Spirometry evaluates how much and how fast an individual can exhale air, lung volume (also known as plethysmography) helps to tell how much air the lungs can hold and how much is left, and lung diffusion capacity gauges if it is easy for oxygen to enter the bloodstream.21,22
Although black lung disease is progressive and the damage is irreversible, there are treatments to help alleviate symptoms, improve quality of life, and slow down the progression. Bronchodilators are used to keep airways open, and they can also help fight inflammation. Pulmonary rehabilitation comprises exercises that facilitate patients learning to breathe better. Supplemental oxygen is often be prescribed in more severe cases to help get more air into the lungs. Lung transplants are advised for very severe cases. Clinicians also recommend avoiding any more exposure to coal dust or other lung irritants, including cigarette smoke and vaping.6,7,16
Black lung disease remains a serious and persistent occupational hazard, particularly for coal miners and others exposed to harmful organic or inorganic lung irritants. The ongoing prevalence of the devastating condition underscores the need for continued vigilance, early detection, and comprehensive care, and its irreversible nature highlights the importance of prevention and timely intervention. A strong commitment to protecting workers' health and improving conditions is essential to prevent future cases and support those already affected.
References
1. Cohen RA, Rose CS, Go LHT, et al. Pathology and mineralogy demonstrate respirable crystalline silica is a major cause of severe pneumoconiosis in U.S. Coal miners. Ann Am Thorac Soc. 2022;19(9):1469-1478. Doi:10.1513/AnnalsATS.202109-1064OC
2. Daly M, Willingham L. Coal miners have long faced risk of black lung disease. Now they're getting new protections. AP. April 16, 2024. Accessed August 26, 2024. Https://apnews.Com/article/coal-miners-black-lung-disease-silica-dust-05071eec125cb5be706604aa0fd99299
3. Mayo Clinic staff. Interstitial lung disease. Mayo Clinic. April 25, 2023. Accessed August 23, 2024. Https://www.Mayoclinic.Org/diseases-conditions/interstitial-lung-disease/symptoms-causes/syc-20353108
4. Pneumoconiosis. Johns Hopkins Medicine. Accessed August 23, 2024. Https://www.Hopkinsmedicine.Org/health/conditions-and-diseases/pneumoconiosis#:~:text=Pneumoconiosis%20is%20one%20of%20a,usually%20take%20years%20to%20develop
5. Pneumoconiosis. In: DeLight N, Sachs H. StatPearls. StatPearls Publishing LLC; 2024. Https://www.Ncbi.Nlm.Nih.Gov/books/NBK555902/#:~:text=Pneumoconiosis%20is%20any%20lung%20disease,known%20as%20an%20occupational%20disease
6. Black lung disease (coal workers' pneumoconiosis). Cleveland Clinic. Accessed August 23, 2024. Https://my.Clevelandclinic.Org/health/diseases/25135-black-lung-disease
7. Coal worker's pneumoconiosis (black lung disease). American Lung Association. Accessed August 23, 2024. Https://www.Lung.Org/lung-health-diseases/lung-disease-lookup/black-lung
8. Black lung disease. Britannica. Updated July 28, 2024. Accessed August 23, 2024. Https://www.Britannica.Com/science/black-lung
9. Donaldson K, Wallace WA, Elliot TA, Henry C. Coal worker's pneumoconiosis (black lung disease). J R Coll Physicians Edinb. 2017;47(3):296-302. Doi:10.4997/JRCPE.2017.317 https://pubmed.Ncbi.Nlm.Nih.Gov/29465110/
10. Summit Consulting. Black Lung Incidence Study Final Report. US Department of Labor. October 2023. Accessed August 23, 2024. Https://www.Dol.Gov/sites/dolgov/files/OASP/evaluation/pdf/Black-Lung-Incidence-Study-Final-Report-508.Pdf
11. About the Appalachian region. Accessed August 23, 2024. Https://www.Arc.Gov/about-the-appalachian-region/
12. Maher K. Black lung resurgence prompts new mining rules. The Wall Street Journal. August 28, 2023. Accessed August 24, 2024. Https://www.Wsj.Com/health/healthcare/black-lung-resurgence-prompts-new-mining-rules-8e4c1629
13. Coal worker's pneumoconiosis symptoms and diagnosis. American Lung Association. Updated June 7, 2024. Accessed August 23, 2024. Https://www.Lung.Org/lung-health-diseases/lung-disease-lookup/black-lung/symptoms-diagnosis
14. About Pneumoconioses. National Institute for Occupational Safety and Health (NIOSH). Accessed August 23, 2024. Https://www.Cdc.Gov/niosh/pneumoconioses/about/index.Html
15. Nunez K. What is black lung disease? Healthline. June 30, 2022. Accessed August 23, 2024.Https://www.Healthline.Com/health/black-lung
16. Coal worker's pneumoconiosis. Penn Medicine. Accessed August 24, 2024. Https://www.Pennmedicine.Org/for-patients-and-visitors/patient-information/conditions-treated-a-to-z/coal-workers-pneumoconiosis
17. Tests for lung disease. National Heart, Blood, and Lung Institute. Accessed August 24, 2024. Https://www.Nhlbi.Nih.Gov/health/lung-tests#:~:text=A%20chest%20X%2Dray%20is,lung%20tissue%20scarring%2C%20called%20fibrosis.
18. Haederle M. Contrast caution. The University of New Mexico Health Sciences. February 24, 2022. Accessed August 24, 2024. Https://hsc.Unm.Edu/news/2022/02/doctor-researches-toxic-side-effects-rare-earth-metals-mri.Html
19. Ferris N, Goergen S. Gadolinium contrast medium (MRI contrast agents). Inside Radiology. Accessed August 24, 2024. Https://www.Insideradiology.Com.Au/gadolinium-contrast-medium/
20. Instructions for black lung physical examination (guide to completing form Cm-988). US Department of Labor. Updated August 2017. Accessed August 24, 2024. Https://www.Dol.Gov/agencies/owcp/dcmwc/CM-988A
21. Pulmonary function tests. Johns Hopkins Medicine. Accessed August 24, 2024. Https://www.Hopkinsmedicine.Org/health/treatment-tests-and-therapies/pulmonary-function-tests#:~:text=Pulmonary%20function%20tests%20(PFTs)%20are,treatment%20of%20certain%20lung%20disorders
22. Pulmonary function tests (PFTs). City of Hope. Updated September 27, 2022. Accessed August 24, 2024. Https://www.Cancercenter.Com/cancer-types/lung-cancer/diagnosis-and-detection/pulmonary-function-tests#:~:text=The%20three%20main%20PFT%20types,testing%20and%20lung%20diffusion%20capacity
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