Metastatic Carcinoid Disease Presenting Solely as High-Output Heart Failure
Authors: Douglas Yun
Journal: Annals of Internal Medicine (1994)

Brief Reports1 January 1994Metastatic Carcinoid Disease Presenting Solely as High-Output Heart FailureDouglas Yun, MD and J. Thomas Heywood, MDDouglas Yun, MDFrom Loma Linda Jerry L. Pettis Memorial Veterans Hospital and Loma Linda University Medical Center, Loma Linda, California. and J. Thomas Heywood, MDFrom Loma Linda Jerry L. Pettis Memorial Veterans Hospital and Loma Linda University Medical Center, Loma Linda, California.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-120-1-199401010-00008 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail 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 ReportA 54-year-old white man presented with fatigue and a 20-kg weight loss during the previous 6 months. He could ...References1. Schwaber JR, Lukas DS. Hyperkinemia and cardiac failure in the carcinoid syndrome. Am J Med. 1962; 32:846-53. Google Scholar2. Rudolph AM, Paul MH. Pulmonary and systemic vascular response to continuous infusion of 5-hydroxytryptamine (serotonin) in the dog. Am J Physiol. 1957; 189:263-8. Google Scholar3. MacCanon DM, Horvath SM. Some effects of serotonin in pentobarbital anesthetized dogs. Am J Physiol. 1954; 179:131-4. Google Scholar4. Lundin L, Norheim I, Landelius J, Oberg K, Theodorsson-Norheim E. Carcinoid heart disease: relationship of circulating vasoactive substances to ultrasound-detectable cardiac abnormalities. Circulation. 1988; 77:264-9. Google Scholar5. Okumura K, Yasue H, Ishizaka H, Ogawa H, Fujii H, Yoshimura M. Endothelium-dependent dilator response to substance P in patients with coronary spastic angina. J Am Coll Cardiol. 1992; 20:838-44. Google Scholar6. Morimoto H, Murai M, Maeda Y, Yamaoka M, Nishikawa M, Kiyotoh S, et al. FK 224, a novel cyclopeptide substance P antagonist with NK1 and NK2 receptor selectivity. J Pharmacol Exp Ther. 1992; 262:398-402. Google Scholar7. Morimoto H, Murai M, Maeda Y, Hagiwara D, Miyake H, Matsuo M, et al. FR 113680: a novel tripeptide substance P antagonist with NK1 receptor selectivity. Br J Pharmacol. 1992; 106:123-6. Google Scholar8. Garret C, Carruette A, Fardin V, Moussaoui S, Peyronel JF, Blanchard JC, et al. Pharmacological properties of a potent and selective nonpeptide substance P antagonist. Proc Natl Acad Sci U S A. 1991; 88:10208-12. Google Scholar Author, Article, and Disclosure InformationAffiliations: From Loma Linda Jerry L. Pettis Memorial Veterans Hospital and Loma Linda University Medical Center, Loma Linda, California.Corresponding Author: 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. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byCardiac Complications 1 January 1994Volume 120, Issue 1Page: 45-46KeywordsCarcinoid tumorCardiac outputHeart diseasesHeart failureLesionsSerotoninSystemic vascular resistanceUrineValvular diseasesVasodilators Issue Published: 1 January 1994 Copyright & PermissionsCopyright © 1994 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...