SHM Converge Scientific Abstract ePoster Gallery-Early-Onset Carcinoid Heart Disease: A Rare Presentation in Youth

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A 21-year-old man with no significant past medical history presented with four months of progressive shortness of breath and bilateral leg swelling. Examination showed signs of severe right-sided heart failure, including jugular venous distention, hepatojugular reflux, pitting edema to the hips, and a harsh systolic murmur at the right lower sternal border. He also had a flushing rash on the chest, face, and upper extremities, and reported chronic diarrhea for four years.<br /><br />Laboratory testing showed elevated alkaline phosphatase and BNP, while troponin and TSH were normal. EKG demonstrated sinus tachycardia with right axis deviation and incomplete right bundle branch block. Transthoracic echocardiography revealed severe tricuspid regurgitation caused by poor leaflet coaptation, suggesting carcinoid heart disease. CT angiography of the chest excluded pulmonary embolism but incidentally found multiple liver masses. MRI confirmed diffuse hepatic metastatic disease with mesenteric lymphadenopathy. A 24-hour urine 5-HIAA was markedly elevated, and liver biopsy showed a well-differentiated grade 1 neuroendocrine tumor.<br /><br />The patient was diagnosed with carcinoid syndrome complicated by carcinoid heart disease. Treatment focused on symptom control with intravenous diuretics for heart failure and octreotide for flushing and diarrhea. He improved and was discharged on oral diuretics and octreotide, with plans for oncology follow-up and cardiothoracic surgery evaluation for tricuspid valve replacement.<br /><br />The report emphasizes that carcinoid heart disease usually affects older adults and is often diagnosed late. This case highlights the importance of considering carcinoid syndrome in young patients who present with right-sided heart failure, flushing, diarrhea, and metastatic liver disease.

Asset Subtitle

James Elliott

Meta Tag

Author List Adam Coleman, Aram Bejnood, James Elliott, Jessica Ammon, Natalie Dunlap

Category Clinical Vignettes

Concept Carcinoid Syndrome

Concept Carcinoid Heart Disease

Concept Right Heart Failure

Concept Tricuspid Regurgitation

Concept Neuroendocrine Tumor

Distinguished Non-Finalist

Presenter Organization The University of Tennessee Health Science Center College of Medicine

Presenting Author James Elliott

Track Adult

Keywords

carcinoid syndrome

carcinoid heart disease

right-sided heart failure

tricuspid regurgitation

neuroendocrine tumor

hepatic metastases

flushing rash

chronic diarrhea

elevated 5-HIAA

octreotide

Carcinoid Syndrome

Carcinoid Heart Disease

Right Heart Failure

Tricuspid Regurgitation

Neuroendocrine Tumor