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Question of the Day
A 57-year-old woman with abdominal pain and diarrhea is diagnosed with a carcinoid tumor of her small intestine. Which of the following is the MOST common cardiac manifestation of carcinoid syndrome?
Explanation
Carcinoid tumors are most commonly found along the gastrointestinal tract (approximately 75% of cases), most frequently occurring in the appendix, ileum, and rectum. These tumors may also be found in the lungs, ovaries, thyroid, and multiple other locations throughout the body. Carcinoid tumors are derived from neuroendocrine cells. Approximately 10-20% of patients go on to develop carcinoid syndrome due to the release of vasoactive substances from these tumors, most notably serotonin. The classic "carcinoid triad" is used to describe the most common signs and symptoms of carcinoid syndrome: diarrhea, flushing, and cardiac manifestations. The cardiac manifestations of carcinoid syndrome are typically a result of fibrosis of valvular endocardium, more commonly involving the right side of the heart, thereby affecting the tricuspid valve and/or pulmonary valve.
References:
Carcinoid SyndromeHines RL, Marschall KE. Handbook for Stoelting’s Anesthesia and Co-existing Disease, 4th ed. Philadelphia, PA: Elsevier/Saunders; 2013: 14: pp. 174-176.
Miller RD, ed. Miller’s Anesthesia. 8th ed., ebook. St. Louis, MO: Elsevier Saunders; 2015: 39: pp. 1208-1211.
