RSS Feeds
Metastatic Carcinoid Disease Presenting Solely as High-Output Heart Failure
- Douglas Yun, MD; and
- J. Thomas Heywood, MD
- From Loma Linda Jerry L. Pettis Memorial Veterans Hospital and Loma Linda University Medical Center, Loma Linda, California. Requests for Reprints: J. Thomas Heywood, MD, Cardiology Section, Loma Linda Jerry L. Pettis Memorial Veterans Hospital, 11201 Benton Street, Loma Linda, CA 92357. Acknowledgments: The authors thank Dr. O'Dorisio and his staff at The Ohio State University Hospital Laboratory for their analysis of the serum sample for substance P.
Metastatic carcinoid disease can result in congestive heart failure by causing progressive endocardial fibrosis of right-sided chambers and valves. We report an unusual case of metastatic carcinoid disease with high-output heart failure without the typical features of cutaneous flushing and valvular lesions. The patient's urine level of 5-HIAA was only mildly elevated, but substance P, a powerful vasodilator, was markedly elevated. In this patient, high-output congestive heart failure was the sole manifestation of a carcinoid tumor producing substance P.
Case Report
A 54-year-old white man presented with fatigue and a 20-kg weight loss during the previous 6 months. He could walk only two blocks and had noted increasing abdominal girth. He denied orthopnea, paroxysmal nocturnal dyspnea, and lower-extremity swelling. He also denied abdominal pain, hematochezia, melena, diarrhea, and flushing. He was thin, mildly tremulous, and afebrile and had no evidence of sepsis. His blood pressure was 112/70 mm Hg, and his pulse was 110 beats/min. His thyroid gland was normal. The jugular venous pressure was 15 cm H2O. A cardiac examination showed a 2 to 3+ parasternal …
