Examination Panel for Cardiac Sarcoidosis

Sarcoidosis can affect multiple systems throughout the body, making its diagnosis relatively complex. Only about 5 percent of cardiac sarcoidosis patients exhibit clear symptoms.

Therefore, various tests are required to establish the diagnosis, including:

1. Echocardiogram:

Using sound wave technology to visualize abnormalities in the heart muscles and heart valves.

2. Electrocardiogram (EKG):

A test to identify disturbances in the heart's rhythm. It can also detect repolarization disorders and ectopic beats.

3. Holter Monitor:

Continuous monitoring of the heart's rhythm for one or two days using a specialized device to determine if the rhythm is abnormal.

4. Nuclear Imaging:

A radioactive technology used to measure inflammation and cardiac activity.

5. Magnetic Resonance Imaging (MRI):

Used to visualize cardiac abnormalities.

6. Biopsy:

Tissue samples are taken to identify the presence of granulomas. The examination of tissue samples taken through this process is called histological examination. The purpose of the histological examination is to demonstrate the presence of granulomatous inflammation with mononuclear cells.

Lung involvement in sarcoidosis can be detected through biopsies of bronchi guided by ultrasound (endobronchial ultrasound-guided transbronchial needle aspirate/EBUS-TBNA) and transbronchial and endobronchial biopsies, which may show atypical non-necrotizing granulomas.

Blood tests can also be conducted to count blood cells, measure hormone levels, and assess liver and kidney function.

Leukocyte differential count in sarcoidosis may reveal lymphopenia. If hepatic involvement is present, the serum alkaline phosphatase level and liver function tests may show elevation.

Kidney function tests in sarcoidosis may show increased blood urea and creatinine, especially if the disease affects the renal organs. Urinalysis in sarcoidosis may also indicate hypercalciuria.

7. Pulmonary Function Tests:

Used to measure lung volume and capacity.

8. Chest X-ray:

To detect granulomas or lung tissue and enlargement of the heart or lymph nodes.

Chest X-ray examination in sarcoidosis patients generally reveals bilateral hilar lymphadenopathy, disseminated nodules, and air trapping. Interpretation is adjusted to Scadding's staging for sarcoidosis.

9. Magnetic Resonance Imaging (MRI):

Performed in sarcoidosis patients to detect neurological involvement, spinal cord, meninges, and lesions in the pituitary gland.

Some studies suggest that whole-body F(18)-fluorodeoxyglucose positron emission tomography (FDG-PET) scans can assess inflammatory activity in patients with persistent symptoms without an increase in sarcoidosis biomarkers. This examination can detect extrathoracic lesions and be useful in identifying hidden and reversible granulomas in sarcoidosis patients.

Author: Dr. Fatimah Bebi (Laboratory Medical Services Doctor at PRAMITA Clinic, Jl. Diponegoro No. 37 Medan)