Echocardiographic Findings in Carcinoid Syndrome

Abstract

A 57-year-old Caucasian female was referred to our Cardiology department due to hypertension, flushing, and diarrhea. She had a medical history of hypertension and paroxysmal atrial fibrillation. On physical examination, the patient had a heart rate of 70 bpm and a respiratory rate of 12 breaths/min. Her temperature was 37°C and her blood pressure was 120/80 mmHg. Cardiac examination revealed a left parasternal holosystolic murmur, and a palpable right ventricular heave. Lung auscultation was unremarkable. From the initial biochemical exam she had no specific abnormalities. The ECG showed sinus rhythm, negative T-waves in leads III, V1-5. The transthoracic echocardiography study revealed a left ventricle with normal size and normal systolic function and dilatation of the left atrium, whereas the right cardiac chambers were dilated with thickened, immobile leaflets of the tricuspid and pulmonic valve, leading to malcoaptation and severe tricuspid and pulmonic regurgitation. (Figures 1-5) The clinical and echocardiographic findings raised the suspicion of carcinoid heart disease. Abdominal CT demonstrated hepatic metastases and the patient was treated with chemotherapy and with the somatostatin analog octreotide... (excerpt)