SHM Converge Scientific Abstract ePoster Gallery-Delayed Cardiac Sequelae: Carcinoid Heart Disease Manifesting 10 Years Post Diagnosis

Pdf Summary

This case describes a 63-year-old man with metastatic carcinoid disease who developed severe carcinoid heart disease (CHD) 10 years after his original diagnosis and small-bowel resection. He presented with abdominal distention, watery diarrhea, facial flushing, anasarca, and bilateral leg edema. Exam revealed a loud systolic murmur and signs of right-sided heart failure. His plasma 5-HIAA was markedly elevated, supporting active carcinoid syndrome.<br /><br />Cardiac workup showed that a transthoracic echocardiogram performed one year earlier had been normal, but repeat imaging during this admission demonstrated rapid progression to severe valvular disease: thickened tricuspid valve leaflets fixed in an open position with torrential tricuspid regurgitation, moderate-to-severe pulmonic regurgitation, and a patent foramen ovale. Right and left heart catheterization found elevated central venous pressure and no ischemic coronary disease. He underwent tricuspid and pulmonic valve replacements as well as PFO closure.<br /><br />The report highlights that CHD is caused by plaque-like fibrous deposits on the heart, most often affecting the tricuspid valve, and may also cause arrhythmias, coronary vasospasm, and direct myocardial involvement. Although cardiac involvement can occur in up to 50% of patients with carcinoid disease, it is usually not the initial presentation. CHD is associated with poor prognosis, especially when advanced heart failure develops.<br /><br />A key teaching point is that CHD can appear many years after the original tumor diagnosis and may worsen quickly, as shown by major valvular deterioration within a single year in this patient. Management requires a multidisciplinary approach, including surgical correction of valvular disease/shunts, guideline-directed heart failure therapy, and treatment of the underlying malignancy with somatostatin analogues such as octreotide.

Asset Subtitle

Pavithra Kannan

Meta Tag

Author List Jay Anderson, Pavithra Kannan

Category Clinical Vignettes

Concept Carcinoid Heart Disease

Concept Right-Sided Valvular Involvement

Concept Fibrous Plaque

Concept Carcinoid Syndrome

Concept Right Heart Failure

Distinguished Non-Finalist

Presenter Organization OhioHealth Riverside Methodist Hospital - Columbus, OH

Presenting Author Pavithra Kannan

Track Adult

Keywords

carcinoid heart disease

metastatic carcinoid

carcinoid syndrome

tricuspid regurgitation

pulmonic regurgitation

right-sided heart failure

5-HIAA

valve replacement

octreotide

patent foramen ovale

Carcinoid Heart Disease

Right-Sided Valvular Involvement

Fibrous Plaque

Carcinoid Syndrome

Right Heart Failure