Carcinoid heart disease. Clinical and echocardiographic spectrum in 74 patients.

Pellikka, Patricia A.; Tajik, A. Jamil; Khandheria, Bijoy K.; Seward, James B.; Callahan, John A.; Pitot, Henry C.; Kvols, Larry K.

doi:10.1161/01.cir.87.4.1188

Cited by 540 publications

(492 citation statements)

References 15 publications

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“…Cuando existe compromiso cardiaco la sobrevida a tres años es de 31% comparada a 68% sin la afección en cuestión. Se ha descrito aumento en la sobrevida de 1,5 a 4,4 años en las últimas dos décadas con los avances en el manejo 4 , principalmente al uso más frecuente de cirugía valvular, citorreducción quirúrgica del tumor primario, terapia ablativa de las metástasis hepáticas y uso de análogos de somatostatina.…”

Section: Discussionunclassified

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Síndrome carcinoide y compromiso valvular cardiaco, a propósito de 2 casos: Report of two cases

et al. 2014

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Section: Discussionunclassified

“…La enfermedad carcinoide cardiaca ocurre en alrededor de 50% 3 de los pacientes con síndrome carcinoide y puede ser la presentación inicial en alrededor de 20% de los pacientes 4 .…”

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Síndrome carcinoide y compromiso valvular cardiaco, a propósito de 2 casos: Report of two cases

et al. 2014

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“…Carcinoid heart lesions are characterized by plaque-like and fibrous endocardial thickenings, which may cause retraction and fixation of the leaflets of the tricuspid and pulmonary valves. Tricuspid regurgitation is characteristic, but tricuspid stenosis, pulmonary regurgitation and pulmonary stenosis may also occur (3,5,6). Endocardial involvement suggests an advanced disease process (1,3,6).…”

Section: Discussionmentioning

confidence: 99%

“…The valves and endocardium of the right side of the heart are classically involved because lung tissue inactivates vasoactive humoral substances, thus sparing the left heart. Left-sided valvular pathology occurs in less than 10% of patients with cardiac involvement and is mostly associated with a right-to-left shunt, or a primary bronchial carcinoid or carcinoid metastases to the lungs (5,8). These abnormalities allow serotonin-rich venous blood to enter the left heart chambers without passing through the pulmonary capillaries (1,6).…”

Section: Discussionmentioning

confidence: 99%

A most unusual acute coronary syndrome

Bourgault

Bergeron

Bogaty

et al. 2006

Canadian Journal of Cardiology

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A 60-year-old man with a seven-year history of coronary artery disease was admitted for suspected unstable angina. He was well until two weeks previously, when he experienced several episodes of squeezing chest pain while at rest, lasting 5 min to 15 min, accompanied by dyspnea and sweating. Episodes were relieved by sublingual nitroglycerine. In the previous month, the patient had also noted progressive dyspnea on light exertion and new-onset nocturnal dyspnea, with recent episodes of flushing and diarrhea. He had unaccountably lost 22.7 kg in the preceding four months. Night sweats and fever were absent. Recently, furosemide 40 mg had been added to control new-onset lower limb edema. Other daily medications were acetylsalicylic acid 81 mg, valsartan 80 mg and lovastatin 20 mg.In the emergency room, the physical examination showed a mildly obese man without distress. Central venous pressure was elevated with V waves. A grade II/VI holosystolic regurgitant murmur was heard at the left and right sternal borders. Lung auscultation was normal, and a 2 cm pitting edema was noted at the ankles with stasis dermatitis. The electrocardiogram (ECG) was normal and cardiac troponin was negative. The patient was admitted with a diagnosis of acute coronary syndrome. The patient was started on heparin, nitrates and a betablocker. Echocardiography showed normal left ventricular systolic function with grade 2 mitral and grade 3 tricuspid regurgitation. The sonographer also reported abnormal hepatic lesions compatible with liver metastases.During his hospital stay, the patient presented with several episodes of chest pain at rest. The ECG showed a junctional rhythm with ST segment elevation in the inferior leads (II, III and aVF) and ST segment depression in the other leads ( Figure 1). Coronary angiography showed diffuse disease with 70% stenosis in the mid segment of the left anterior descending coronary artery and a 50% stenosis on the second diagonal CASE REPORT ©2006 Pulsus Group Inc. All rights reserved C Bourgault, S Bergeron, P Bogaty, P Poirier. A most unusual acute coronary syndrome. Can J Cardiol 2006;22(5):429-432.A 60-year-old man, known for stable coronary artery disease, was admitted for suspected unstable angina. In the previous month, the patient presented with progressive dyspnea on light exertion. In the preceding four months, he had experience occasional episodes of flushing and diarrhea, and had inexplicably lost 22.7 kg. Night sweats and fever were absent. ST segment elevation in the inferior leads and ST segment depression in the precordial leads were documented during an episode of chest pain. The coronary angiogram showed diffuse disease with 70% stenosis of the left anterior descending coronary artery and 50% stenosis on the second diagonal (D 2 ). An echocardiogram showed a patent foramen ovale. Balloon angioplasty and stenting were performed on the two lesions. Two days later, prolonged chest pain recurred. Cardiac catheterization was repeated and showed occlusive thrombus within the stent on the D 2 ...

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“…As lesões carcinóides, que em cerca de 80% dos casos localizam-se no intestino, associam-se à cardiopatia valvar em 50% dos casos: insuficiência tricúspide associada ou não a estenose, em praticamente todos, insuficiência/estenose pulmonar, na maioria, e comprometimento mitral, por vezes com de aórtica, em menos do que 10% dos casos 10,11 . Os achados morfológicos (ecocardiográficos e anatomopatológicos) superpõem-se aos descritos com as referidas drogas.…”

Section: Nossas Observaçõesunclassified

O vínculo droga valvopatia

Grinberg

Halpern

Rossi

et al. 1998

Arq. Bras. Cardiol.

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Ação de droga não é fator etiopatogênico habitualmente cogitado perante valvopatia adquirida. Não obstante, efeitos adversos de remédios anti-enxaqueca 1-5 e anorexígenos 6,7 estão vinculados a casos de cardiopatia valvar, alguns inclusive submetidos à correção cirúrgica. Derivados do ergotMetisergida 2-5,8 -Nas décadas de 60/70, o derivado do ergot metisergida era o mais eficaz profilático para enxaqueca. Na ocasião, estimava-se o consumo em 500 mil pessoas.Em 1964, John Graham, então diretor da Headache Research Foundations, em Boston, foi alertado sobre a ausculta de sopros de insuficiência mitral ou aórtica durante uso contínuo da droga.Uma primeira avaliação, compreendendo 27 pacientes com casos de fibrose retroperitonial induzida pela metisergida, revelou sete (26%) casos com sopro cardíaco. Em período de dois anos, o pesquisador pôde observar o desenvolvimento sem outra causa aparente de sopro cardíaco expressivo em 16 de seus pacientes.Dez anos após a constatação original, revisão publicada pelo mesmo Serviço incluiu não mais do que 48 casos de vínculo da droga com sopro cardíaco.Este número restrito de casos foi suficiente para incorporar as seguintes observações ao conhecimento sobre cardiopatia valvar: 1) taxa de 3,6% dos pacientes sob uso continuado de metisergida desenvolve sopro cardíaco. Devemos conjecturar que lesões valvares subclínicas, atualmente identificáveis pela ecocardiografia, possam ter ficado à margem desta proporção; 2) a maioria dos pacientes não apresentava sopro cardíaco previamente ao uso; 3) não havia outra causa de sopro cardíaco; 4) a intensidade do sopro cardíaco mostrou-se inicialmente crescente; 5) a suspensão da droga associou-se à regressão total (46%) ou parcial (12%) do sopro cardíaco em 58% dos casos; 6) os sopros reveladores de estenose e/ou insuficiência tinham origem nas valvas mitral, aórtica e tricúspide; 7) sopro cardíaco superpôs-se em 26% ao desenvolvimento de fibrose retroperitonial, condição também, potencialmente, reversí-vel com a suspensão da droga; 8) o exame anatomopatológico das valvas que vieram a ser operadas ou estudadas à necropsia revelou características similares entre si de comprometimento de folhetos valvares, cordas tendíneas e músculos papilares; 9) o aspecto patológico fundamental é um processo fibroproliferativo, que se desenvolve como uma camada de revestimento de tecido colágeno. Não há destruição da estrutura valvar subjacente. Este aspecto o diferencia da doença reumática; 10) o processo fibrótico da valva aórtica pode se estender para a parede ventricular esquerda, aorta e óstio de artéria coronária (causa documentada de infarto do miocárdio).A orientação clínica para uso da metisergida passou a se restringir a: 1) formas graves de enxaqueca; 2) pacientes confiáveis para cumprir rigorosamente a orientação de suspender, periodicamente, o medicamento e se submeter a exames de controle; 3) acréscimo das seguintes contra-indicações às vigentes: lesões valvares, descompensação cardíaca de qualquer causa, doenças associadas a estados de fibros...

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Carcinoid heart disease. Clinical and echocardiographic spectrum in 74 patients.

Abstract: The broad spectrum of carcinoid heart disease is detailed in this large series. This includes not only right-sided valvular lesions but also left-sided involvement, pericardial effusion, and myocardial metastases.

Cited by 540 publications

References 15 publications

Síndrome carcinoide y compromiso valvular cardiaco, a propósito de 2 casos: Report of two cases

Síndrome carcinoide y compromiso valvular cardiaco, a propósito de 2 casos: Report of two cases

A most unusual acute coronary syndrome

O vínculo droga valvopatia

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