Zusammenfassung
Die Sarkoidose ist eine Systemerkrankung, bei der die frühzeitigen entzündlichen und
unter Therapie rückbildungsfähigen Organveränderungen häufig subklinisch verlaufen.
Bei narbigen Residuen ist oft keine Besserung mehr zu erreichen. Ein fortschreitender
Funktionsverlust bis zum Organversagen kann auftreten. Der Beteiligung des Herzens
kommt dabei eine wesentliche prognostische Bedeutung zu. Ein frühzeitiger Therapiebeginn
mit Kortikosteroiden vor Auftreten irreversibler Funktionsstörungen des Herzens geht
mit einer exzellenten Prognose einher. Die technischen Entwicklungen in den bildgebenden
Verfahren haben zwar die grafische Darstellung von Struktur und Funktion des Herzens
deutlich verbessert, dennoch ist bislang kein einzelnes Verfahren in der Früherkennung
zuverlässig. Die Kombination verschiedener Verfahren und der klinischen Beschwerden
erlaubt jedoch häufig eine frühe Diagnosestellung. Entscheidend ist das „daran denken”
und die rechtzeitige Einleitung einer weiterführenden Diagnostik bei entsprechenden
Beschwerden. In der spezifischen Therapie fehlen weiterhin Alternativen zur Kortisontherapie.
Die symptomatische kardiale Behandlung orientiert sich wesentlich an der Behandlung
dilatativer Kardiomyopathien, da in vielen Frage wie z. B. der anti-arrhythmischen
Therapie oder der Indikation zur Implantation antitachykarder Schrittmachersysteme
keine, eigenständigen verlässlichen Studien zur Herzsarkoidose vorliegen.
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Dr. W. Schulte
Ruhrlandklinik
Tüschener Weg 40
45239 Essen
Email: schulte-adams@t-online.de
