Carcinoid Heart Disease: A Review
Thiago Andrade Macedo *
Cardiology Division, Heart Institute (InCor), Medical School of the University of São Paulo, São Paulo, Brazil
Roberto Nery Dantas Júnior
Cardiology Division, Heart Institute (InCor), Medical School of the University of São Paulo, São Paulo, Brazil
Ismar Aguiar Marques Filho
Cardiology Division, Heart Institute (InCor), Medical School of the University of São Paulo, São Paulo, Brazil
Pedro Gabriel Melo de Barros e Silva
Cardiology Division, Heart Institute (InCor), Medical School of the University of São Paulo, São Paulo, Brazil
Liliane Gomes da Rocha
Cardiology Division, Heart Institute (InCor), Medical School of the University of São Paulo, São Paulo, Brazil.
Bernardo Baptista da Cunha Lopes
Cardiology Division, Heart Institute (InCor), Medical School of the University of São Paulo, São Paulo, Brazil
Marcio Campos Sampaio
Cardiovascular Imaging Division, Dante Pazzanese Institute of Cardiology, São Paulo, Brazil.
*Author to whom correspondence should be addressed.
Abstract
Carcinoid tumors are rare malignancies able to spread and produce bioactive humoral products, mainly serotonin, which is responsible for the Carcinoid Syndrome (CS); its features are: flushing, diarrhea, bronchospasm and valvular heart disease. The Carcinoid Heart Disease (CHD) importantly worsens prognosis and it is found in up to 50% of patients with CS. After being produced by liver implants, serotonin finds its way straight into the right heart cavities, leading to valve tissue aggression and ventricular dysfunction. Early CHD diagnosis is still a challenge due to the asymptomatic initial stage, until right heart failure develops along with ascites, swelling and hepatomegaly. Echocardiography is still the main tool for diagnosis, especially due to its ability to appropriately evaluate ventricular and valve function, cardiac morphology and hemodynamics. Tricuspid regurgitation, pulmonic stenosis and dilated cardiomyopathy are the main impairments found in CHD. Magnetic resonance imaging has also developed well in this field, and it is now believed to be essential, due to accurate right cavities evaluation and fibrosis detection. For better prognosis, early diagnosis must be pursued, which has impact on clinical management and valve repair surgical decision.
Keywords: Carcinoid syndrome, carcinoid heart disease, neuroendocrine tumor