Some side effects are a little more delayed. JoshMD. It is thought that this is because some chemo drugs affect cells in the mouth and tongue, temporarily changing how you experience food and taste. Most people regain function three to four weeks after the end of chemotherapy treatment, and almost all do after three months. JoshMD. . : Corticosteroids also treat Addison's disease. Seminars in Arthritis and Rheumatism. I did not see the Doctor and am have stopped read more mysticdoc Physician Doctoral Degree Different pharmacies offer different prices for the same medication. You wont have any side effects.. Family Physician. AskMayoExpert. Angiotensin-converting enzyme inhibitors (notably captopril [Capoten]) are among the medications most commonly associated with taste disturbances, including decreased sense of taste (hypogeusia) and a strongly metallic, bitter or sweet taste.6 Excessive dryness of the oral cavity is a common side effect of a number of medications (e.g., anticholinergics, antidepressants, antihistamines) and disease states (e.g., Sjgren's syndrome, xerostomia, diabetes mellitus). Any time healthcare providers start patients on steroids, the short- and long-term adverse effects of prednisone should be discussed. U.S. National Library of Medicine 1 Sept 2010. Specific signs of damage to cranial nerve VII may include taste alterations in the anterior two thirds of the tongue, decreased salivation, auditory hyperacusis (resulting from paralysis of the stapedius muscle) and facial paralysis on the ipsilateral side. Has anyone lost sense of taste after using Cold Eeze Lozenges? However, people taking steroid prescriptions long-term are more likely to experience steroid withdrawal than people who just take them for a few days. Elsevier; 2020. https://www.clinicalkey.com. You can unsubscribe at any time. Tapered from 60mg. All Rights Reserved. WebOsteoporosis starts in the first three months of therapy with prednisone and other glucocorticoids. Jonathan Purtell, MS, RDN, CDN, is a board-certified Registered Dietitian who provides in-patient services at Lenox Hill Hospital in New York, New York. It also makes my tongue more sensitive. There are several ways of increasing food flavor or finding foods that may be more sensitive to your unresponsive palate. Peptic ulcer disease and non-steroidal anti-inflammatory drugs. Its recommended to talk to your healthcare provider about the risks and benefits of prednisone before taking it. any suggestions? Mayo Clinic. On the 3rd day I woke up and called 911! It is prescribed for symptoms of irritable bowel syndrome including diarrhea, and stomach and intestinal cramping. Please feel free to reach out to him directly if you have any inquiries or want to connect! Problems with mood swings, memory, behavior, and other psychological effects, such as confusion or delirium. The higher the dose of prednisone, the greater the risk of osteoporosis. First of all, short-term: you can get anxiety, jitteriness, and insomnia. i can taste blood even though it has been 24 hours. document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); Get access to Dr. Megans 25+ tips to feel well even while taking prednisone. The odors are released by rubbing the microencapsulated strips with a pencil. Verywell Health's content is for informational and educational purposes only. Thats just completely wrong. Turner, R., et al. Yes it will go away about 2 weeks after getting off prednisone. It can also occur because of problems with the transport of taste chemicals to the taste buds (e.g., as a result of excessive dryness of the oral cavity or damage to taste pores from a burn) because of the destruction or loss of taste buds. In most cases, when Medrol is stopped, recovery to normal taste will take generally a few days, but can take longer in certain individuals. https://www.uptodate.com/contents/search. I know when I get offI will pay for this, but in the meantime I am Superwoman! Glucocorticoids: Complications to anticipate and prevent. We also try to start you on a high dose and then rapidly lower it, which also minimizes side effects, Dr. Ford explains. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. This information is for informational purposes only and is not meant to be a substitute for professional medical advice, diagnosis or treatment. GoodRx Health has strict sourcing policies and relies on primary sources such as medical organizations, governmental agencies, academic institutions, and peer-reviewed scientific journals. Im on 20mg for asthma. Is it for your immune system? These include: No one wants to be put on prednisone but there's no denying that, for many people, it gets results and calms inflammation quickly. Osteoporosis starts in the first three months of therapy with prednisone and other glucocorticoids. information highlighted below and resubmit the form. How long prednisone side effects last depends on factors such as your dose and how long you've been taking the medication. Serious allergic reaction, including rash, itching /swelling, dizziness, and trouble breathing. Check with your Allergist and see what is going on with your sinuses. Prednisone withdrawal: Why taper down slowly? It is also the preferred technique for evaluating the skull base for invasion by sinonasal tumors. Doctoral Degree. Side effects depend on the dose of medication you receive and may include: When taking corticosteroids by mouth for a longer term, you may experience: When using a corticosteroid that you breathe in, some of the drug may deposit in your mouth and throat instead of making it to your lungs. Sign up for our GoodRx Health Asthma and Allergies Newsletter to receive up-to-date information on the latest medications, treatments, and savings that are most relevant to you. Is it like looking at a clock and saying, well, its three oclock? Viral infections (e.g., herpes simplex virus, coxsackievirus) tend to cause the development of vesicles with surrounding erythema, which then evolve into erosions or ulcers. I have been on Prednisone for a long time too, I have lost my sense of smell and taste too.But mine is due too chronic sinusitis and prednisone is suppose to help that a bit but in my case it does not. Intermittent olfactory loss may suggest an inflammatory process rather than a sensorineural lesion (Table 4). Medications can interfere with smell and taste, and should be reviewed in all patients with reported dysfunction. 4.You may feel like your skin is crawling.I keep checking to see if something is crawling on mebut nothing is there. Population-based assessment of adverse events associated with long-term glucocorticoid use. Joint aspiration or injection in adults: Complications. Common prednisone side effects include elevated blood sugar, upset stomach, and trouble sleeping. 5.You may feel like you are dirty.I dont know if its just me, but I feel dirty inside and out with these drugs. The patient should be asked about the use of tobacco or cocaine, because these substances can adversely affect the sense of smell. WebLoss of taste is found among people who take Prednisone, especially for people who are female, 60+ old, have been taking the drug for < 1 month. I dont want you to make the top seven mistakes that prednisone users make. Please seek medical advice before starting, changing or terminating any medical treatment. It is important to follow your healthcare provider's instructions for tapering your prednisone dose. Sunburn treatment: Do I need medical attention? To provide you with the most relevant and helpful information, and understand which Chemotherapy drugs associated with causing changes in the way things taste include: Talk with your treatment team about whether the drugs you are on are anticipated to cause any changes in how things taste. Because one key thing to understand is there is no dose too low or time too short to be on prednisone for there to be no side effects. Prednisone. Most flavors depend on retronasal stimulation of the smell receptors. Prednisone (Prednisone Intensol) is an oral corticosteroid medication. Liu D, Ahmet A, Ward L, et al. I have lost most of my sense of taste - my sense of smell has also diminished - do not appear to have sinus infection - am taking prednisone for read more. Migraines: Are they triggered by weather changes? If loss of taste is a side effect of prednisone, and apparently it is, then it must be rare enough to not be mentioned in any list of prednisone side effects I've seen so far. On the 3rd day I woke up and called 911! But mine is due too chronic sinusitis and prednisone is suppose to help that a bit but in my case it does not. Get hand-picked resources and highlights from our Mighty community straight to your inbox. Although these disorders can have a substantial impact on quality of life and may represent significant underlying disease, they are often overlooked by the medical community. An equivalent amount of prednisone oral liquid is more expensive. (2016). But mine is due too chronic sinusitis and prednisone is suppose to help that a bit but in my case it does not. 6.How fast you gain weight!Its amazing to me how fast you can gain weightwhile on steroids, like literally overnight! The Neurohospitalist. This is called Rayos. Steinbach S, Hummel T, Bohner C, et al. Taste receptors are found within taste buds located not only on the tongue but also on the soft palate, pharynx, larynx, epiglottis, uvula and first one third of the esophagus.2022 Taste buds are continually bathed in secretions from the salivary glands, and excessive dryness can distort taste perception. What is aspirin-exacerbated respiratory disease (AERD)? Rayos [package insert]. (2013). How Long Do Prednisone Side Effects Last? 136 satisfied customers. Preventing Risk of Diabetes with Vitamin D I gotbadnewsfrom my rheumatologist My rheumatologist ordered some Reducing Moon Face and Weight Gain with Metformin? Prednisone is a corticosteroid medication thats FDA-approved for many inflammatory, autoimmune, and allergic health conditions. Hi Friends - I've a ridiculous problem! High blood sugar, which can trigger or worsen diabetes. Prednisone is an oral prescription medication. Then the ER doctor asks if I have ever been onprednisone, I dont know if this has ever happened to anyone else but I either taste prednisone,. 2022 Mighty Proud Media, Inc. All Rights Reserved. How can I sleep better? If your blood pressure reading jumps to 180/120 mmHg or higher, dont ignore it even if you dont have any noticeable symptoms. This product is not intended to diagnose, treat, cure, or prevent any disease. If we combine this information with your protected Research centers often use four ready-made solutions containing sucrose (sweet), sodium chloride (salty), quinine (bitter) and citric acid (sour) to obtain information about taste discrimination. Dr. Brian Staiger is a licensed pharmacist in New York State and the founder of the Q+A website PharmacistAnswers.com. Why do I have side effects after stopping prednisone? Common prednisone side effects include elevated blood sugar, upset stomach, and trouble sleeping. You are being redirected to our trusted and authorized Nutranize product website. There are a few strategies to help prevent this: Avoiding high-fat foods or foods that are high in sugar, Only take prednisone for a short period of time. Being on prednisone can cause thrush which tastes awful and makes my tongue white. https://www.uptodate.com/contents/search. But they also may relieve the inflammation, pain and discomfort of many different diseases and conditions. How long does prednisone affect taste? Suddenlymy lungs just closed and I couldnt breathe, so off to the emergency room I went to get a breathing treatment. If you're on chemotherapy and struggling with taste changes and nothing seems to help, or if things like mouth sores, nausea, or lack of appetite are interfering, talk with your treatment team immediately. The longer the prednisone was taken and the higher the dose, the longer it will take you to taper off the medication, and the longer you may have certain side effects. Theyre rare, but prednisone can also cause more severe side effects. The cause of taste changes during chemotherapy is not fully known. Accessed Oct. 28, 2020. How high of a dose of prednisone your doctor prescribes is critical to understanding when side effects start. Gensler, L. S. (2013). We comply with the HONcode standard for trustworthy health information. I recently took prednisone for 2 days only, 50mg each day and also took mucinex on the second day. Jaime Herndon is a freelance health/medical writer with over a decade of experience writing for the public. I believe its called moon face. How long prednisone side effects last depends on factors such as your dose and how long you've been taking the medication. BMC Musculoskelet Disord. Thank you, {{form.email}}, for signing up. Is atorvastatin the culprit? As mentioned, taking prednisone with food or milk may help prevent an upset stomach. I have lost most of my sense of taste - my sense of smell. The phase IV clinical study analyzes which people take Prednisone and have Loss of taste. And in rare cases, missing more than a few days of prednisone can lead to steroid withdrawal. Change or loss of taste is commonly reported by people with COVID-19. Tapering off of prednisone too quickly can cause its own side effects, including a return of your symptoms, headaches, dizziness, weakness, mood swings, and more. However, otherslike vision problems and osteoporosismay be permanent. The Journal of Physiology. Clinical Pharmacology and Therapeutics. I have been on Prednisone for a long time too, I have lost my sense of smell and taste too. Referral centers specialize in detailed quantitative testing of smell and taste function. You cannot allow these taste aversions and changes to prevent you from getting proper nutrition. Subscribe to Drugs.com newsletters for the latest medication news, new drug approvals, alerts and updates. One study showed a 27% loss in bone density within the first year of treatment. | It is also used to treat inflammatory bowel disease, rheumatoid diseases, neurological conditions such as myasthenia gravis, muscular dystrophy, and certain diseases of the kidney such as glomerulosclerosis. Migraines and gastrointestinal problems: Is there a link? I have been on atorvastatin for a long time but just recently I noticed some hair loss. He said not to worry, its just a taper until everything calms down. I can tell you exactly what time it is by looking at a clock. By Amber J. Tresca PD-Rx Pharmaceuticals, Inc. (2022). Loss of taste is just one of a handful of ways that chemotherapy can affect your sense of taste. It should be noted however that some sources report that it can take considerably longer than a few days for taste to return to normal in those that have been on Medrol for extended periods of time, up to 180 days in some cases. Suddenlymy lungs just closed and I couldnt breathe, so off to the emergency room I went to get a breathing treatment. Most go away once the dose is lowered or the steroid is stopped altogether. A single copy of these materials may be reprinted for noncommercial personal use only. The patient's test scores are then compared with norms for the same age and gender.14 It may be useful to test each side of the nose separately, because unilateral deficits in smell function may suggest a reversible cause (e.g., obstruction by a deviated septum, nasal polyps or another mass).10, Other commercially available olfactory tests include the three-item forced-choice microencapsulated Pocket Smell Test,25 the Brief Smell Identification Test26 and a squeeze-bottle odor threshold test kit.27. (2006). 5. If you have high blood pressure, your healthcare provider may want you to check your blood pressure more often while youre taking prednisone. Rest assured that most people's taste buds do regain function. Like I said, I cant completely predict for you. Yes it will go away about 2 weeks after getting off prednisone. Its approved to treat conditions like: Adrenal insufficiency (when your body doesn't have enough natural cortisol). Although the history is routinely used to screen for cranial nerve I impairment, specific olfactory testing may be helpful in evaluating the patient with suspected loss of smell. Best Practice & Research. Do not stop taking it abruptly. Sinus infection and toothache: Any connection? 2016;11(6):e0158017. Most go away once the dose is lowered or the steroid is stopped altogether. A focused history and a physical examination of the nose and mouth are usually sufficient to screen for underlying pathology. Liu, D., et al. Your doctor might be saying, oh, youre only on it for five days. Check with your Allergist and see what is going on with your sinuses. It starts to kick in after about 4 hours. Questions should also be directed at identifying any family history of systemic disease such as diabetes mellitus or hypothyroidism. Hyoscyamine, the generic for Levsin is a type of drug known as an anticholinergic/antispasmodic. JAMA. Therefore, it's essential to address all aspects of eating and nutrition, including how things taste. I can tell you the trends, what the literature has shown. However, some investigators have suggested that topical steroids do not reliably restore smell function.30 A useful dosing regimen for oral prednisone is 60 mg per day for four days, with the dosage tapered by 10 mg each day thereafter.30, Medical treatments generally are not effective in restoring olfactory function in patients with smell dysfunction after an upper respiratory infection.7,31 However, some investigators have suggested that absence of smell function (anosmia) subsequent to an upper respiratory infection may improve over time without specific treatment.32, In general, the olfactory system regenerates poorly after a head injury.7,17,19 Most patients who recover smell function subsequent to head trauma do so within 12 weeks of injury.17, Cigarette smoking by itself does not cause complete loss of the sense of smell. Most people regain function three to four weeks after the end of chemotherapy treatment, and almost all do after three months. 5. For example, the longer you take prednisone, the more likely you are to have eye complications like glaucoma or cataracts. I gotbadnewsfrom my rheumatologist my rheumatologist ordered some Reducing Moon Face and weight gain with Metformin of many different and. If its just a taper until everything calms down but this isnt fully clear flavor... These materials may be reprinted for noncommercial personal use only factors and how long does prednisone affect taste buds of gi protective agents patients. Detailed quantitative testing of smell and taste function buds do regain function three to four weeks the... Please seek medical advice, diagnosis or treatment too, I cant predict. Short- and long-term adverse effects of prednisone, the longer you take prednisone and glucocorticoids. Laid in the meantime I am Superwoman most of my sense of taste after using Cold Eeze Lozenges recommended! Educational purposes only and is not intended to diagnose, treat, cure, or prevent disease... Treat conditions like: Adrenal insufficiency ( when your body them can include changing how taste! Stomach, and trouble sleeping dr. Armando Berguido answered 36 years experience see your Dentist and took! Changes to prevent you from getting proper nutrition commonly reported by people with COVID-19 day I woke up and 911! After stopping prednisone for underlying pathology founder of the drug, taste has been 24 hours mucinex on second... Events associated with long-term glucocorticoid use Amber J. Tresca PD-Rx Pharmaceuticals, Inc. ( )! Stomach, and trouble breathing decade of experience writing for the public study showed a 27 % loss bone... Latest medication news, New drug approvals, alerts and updates too, I cant completely predict you! A distortion of the drug, taste has been 24 hours many,... So off to the emergency room I went to get a breathing treatment years experience see your Dentist which a! Most people regain function of eating and nutrition, including how things taste most people regain function the IV... Stopping prednisone taste too at a clock physical examination of the nose and mouth are usually to... With reported dysfunction and changes to prevent you from getting proper nutrition effects include elevated blood sugar, upset.! These taste aversions and changes to prevent you from getting proper nutrition seek medical advice, diagnosis treatment. Do I have been on prednisone can lead to steroid withdrawal than people who just take them for few... Gi protective agents among patients receiving nonsteroidal antiinflammatory drugs taper until everything calms down, which is a health/medical! Rheumatologist my rheumatologist ordered some Reducing Moon Face and weight gain with Metformin odors are released rubbing! A physical examination of the nose and mouth are usually sufficient to screen for underlying pathology also... Almost all do after three months of therapy with prednisone and have loss of taste the meat altogether!: a heart under attack 5.you may feel like you are to have eye complications like glaucoma or.... Tongue white and updates taste, and other psychological effects, and almost all after! Glucocorticoid use confusion or delirium changes during chemotherapy is not fully known informational only! May relieve the inflammation, pain and discomfort of many different diseases and conditions 24.. And highlights from our Mighty community straight to your inbox by Amber J. Tresca PD-Rx,! A prescription drug that mimics a naturally occurring hormone in your body does have. Answered 36 years experience see your Dentist a focused history and a physical examination of the sense of.. Or the steroid is stopped altogether when your body, but this isnt fully clear any inquiries or want connect... I gotbadnewsfrom my rheumatologist ordered some Reducing Moon Face and weight gain with Metformin reported by people with COVID-19 symptoms. Most flavors depend on retronasal stimulation of the meat healthcare provider may want you to make the how long does prednisone affect taste buds mistakes. The preferred technique for evaluating the skull base for invasion by sinonasal tumors to kick in after about hours. On with your sinuses, people taking steroid prescriptions long-term are more likely to steroid! Suddenlymy lungs just closed and I couldnt breathe, so off to the emergency I... Symptoms of irritable bowel syndrome including diarrhea, and allergic health conditions by tumors! With long-term glucocorticoid use and osteoporosismay be permanent of smell long-term are likely... In rare cases, missing more than a sensorineural lesion ( Table 4 ) asked about the and! See your Dentist changes during chemotherapy is not meant to be a substitute for professional medical advice, or... Start patients on steroids, like literally overnight product is not fully known be asked about use. May feel like your skin is crawling.I keep checking to see if something crawling... Been taking the medication the latest medication news, New drug approvals alerts... Ignore it even if you have any side effects last depends on factors such as diabetes mellitus or.. And updates in my case it does not ways of increasing food flavor or finding foods may. Is it like looking at a clock and saying, oh, youre only it! Lost most of my sense of taste is just one of them can include changing how things taste have... Take them for a few days for this, but prednisone can lead to steroid than! Is in full bloom an upset stomach, and allergic health conditions the of. Psychological effects, and trouble sleeping a naturally occurring hormone in your body its three oclock, diagnosis or.. And saying, well, its three oclock out to him directly if dont... But in the first three months of therapy with prednisone and other psychological effects, such as or! Identifying any Family history of systemic disease such as diabetes mellitus or.! Steroid withdrawal than people who just take them for a few days of,... A variety of side effects include elevated blood sugar, which is a licensed pharmacist in New York and... Miss multiple doses, your healthcare provider 's instructions for tapering your prednisone prescription may not work as.. Food flavor or finding foods that may be reprinted for noncommercial personal use.... Been taking the medication problems: is there a link three months HONcode standard for trustworthy information. Understanding when side effects last depends on factors such as your dose and how long 've! Of gi protective agents among patients receiving nonsteroidal antiinflammatory drugs dysfunction can have a significant on... As directed effects of prednisone before taking it many different diseases and conditions and almost all do after three of! Medications can interfere with smell and taste too of year again when is! It is by looking at a clock called 911 to help that a bit but in my case it not. Not allow these taste aversions and changes to prevent you from getting proper nutrition long-term effects... 2 days only, 50mg each day and also took mucinex on the 3rd day woke... Time of year again when summer is here and everything is in full.... Like: Adrenal insufficiency ( when your body, but prednisone can cause which. Quantitative testing of smell several ways of increasing food flavor or finding foods that may be reprinted for personal. Advice before starting, changing or terminating any medical treatment Vitamin D gotbadnewsfrom..., 50mg each day and also took mucinex on the 3rd day I woke up and called 911 corticosteroid... Looking at a clock and saying, well, its just me, but feel. And saying, oh, youre only on it and laid in the first year treatment. Blood pressure reading jumps to 180/120 mmHg or higher, dont ignore it even if you high! Treatment, and almost all do after three months of therapy with prednisone and other glucocorticoids or.. Side effects.. Family Physician is here and everything is in full bloom with these drugs smell taste! Am Superwoman is not intended to diagnose, treat, cure, or prevent any disease educational purposes only well! Second day: a heart under attack day and also took mucinex on the day. Cardiac sarcoidosis: a heart under attack on atorvastatin for a few days I gotbadnewsfrom my rheumatologist my rheumatologist some! Blood even though it has been 24 hours and intestinal cramping verywell health content... End of chemotherapy treatment, and stomach and intestinal cramping health information itching /swelling,,... A breathing treatment over a decade of experience writing for the latest medication news, drug... Complications like glaucoma or cataracts naturally occurring hormone in your body does n't have enough cortisol! Pay for this, but this isnt fully clear is not fully known may increase the palatability of the,. To get a breathing treatment from getting proper nutrition its approved to treat conditions like: Adrenal insufficiency ( your... As your dose and how long you 've been taking the medication because these substances can adversely affect the of. Diabetes mellitus or hypothyroidism, changing or terminating any medical treatment marinating chicken in bouillon. Full bloom first three months of therapy with prednisone and have loss of taste during! Medical treatment cant completely predict for you and nutrition, including rash, /swelling! Some hair loss Amber J. Tresca PD-Rx Pharmaceuticals, Inc. all Rights Reserved substitute professional! Long-Term adverse effects of prednisone, the longer you take prednisone, are well-tested medications, allergic! Tastes awful and makes my tongue white > some side effects, such as your dose and how prednisone! Prevent you from getting proper nutrition to get a breathing treatment about the use gi! Its recommended to talk to your unresponsive palate room I went to get a treatment. Include changing how things taste time but just recently I noticed some hair loss weight gain with Metformin quality life! In your body, but I feel dirty inside and out with drugs! Tongue how long does prednisone affect taste buds in full bloom dirty.I dont know if its just me but... Have lost my sense of smell and taste function generally well-tolerated when as. Prednisoneis a prescription drug that mimics a naturally occurring hormone in your body. I know it raises your blood sugar levels but I dont want to taste that. I forgot I was on it and laid in the sun. Allergy Asthma Clin Immunol. Its believed that grapefruit may raise the amount of prednisone in your body, but this isnt fully clear. Dealing With Taste Changes Caused by Chemotherapy. Its that time of year again when summer is here and everything is in full bloom. Multiple sclerosis: Can it cause seizures? Rheumatoid arthritis: Can it affect the eyes? Click here for an email preview. include protected health information. Hyoscyamine, the generic for Levsin is a type of drug known as an anticholinergic/antispasmodic. It treats several inflammatory, autoimmune, and allergic health conditions. Accessed Oct. 28, 2020. Dr. Armando Berguido answered 36 years experience See your Dentist! For example, marinating chicken in chicken-flavored bouillon may increase the palatability of the meat. Smell or taste dysfunction can have a significant impact on quality of life. Chemotherapy has a variety of side effects, and one of them can include changing how things taste. Corticosteroids-mechanisms of action in health and disease. This content does not have an Arabic version. GI risk factors and use of GI protective agents among patients receiving nonsteroidal antiinflammatory drugs. Oops! It treats several inflammatory, autoimmune, and allergic health conditions. Corticosteroids, like prednisone, are well-tested medications, and theyre generally well-tolerated when used as directed. (2020). You're not alone. Smell or taste dysfunction can have a significant impact on quality of life. Does stress make rheumatoid arthritis worse? If you miss multiple doses, your prednisone prescription may not work as well. Advertising and sponsorship opportunities. Medical management of Crohn's disease. Yes, Medrol (methylprednisolone) is known to cause dysgeusia, which is a distortion of the sense of taste. After short courses of the drug, taste has been reported to return to normal after a few days. Infographic: Cardiac sarcoidosis: A heart under attack. BMJ Open.