Multidisciplinary team management of carcinoid heart disease.

Steeds, Richard, Sagar, Vandana, Shetty, Shishir, Oelofse, Tessa, Singh, Harjot, Ahmad, Raheel, Bradley, Elizabeth, Moore, Rachel, Vickrage, Suzanne, Smith, Stacey, Yim, Ivan, Elhassan, Yasir, Venkataraman, Hema, Ayuk, John, Rooney, Stephen and Shah, Tahir (2019) Multidisciplinary team management of carcinoid heart disease. Endocrine connections. ISSN 2049-3614. This article is available to all UHB staff and students via ASK Discovery tool http://tinyurl.com/z795c8c by using their UHB Athens login IDs

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Abstract

Carcinoid heart disease (CHD) is a consequence of valvular fibrosis triggered by vasoactive substances released from neuroendocrine tumours, classically in those with metastatic disease and resulting in tricuspid and pulmonary valve failure. CHD affects 1 in 5 patients who have carcinoid syndrome (CS). Valve leaflets become thickened, retracted and immobile, resulting most often in regurgitation that causes right ventricular dilatation and ultimately, right heart failure. The development of CHD heralds a significantly worse prognosis than those patients with CS who do not develop valvular disease. Diagnosis requires a low threshold of suspicion in all patients with CS, since symptoms occur late in the disease process and clinical signs are difficult to elicit. As a result, routine screening is recommended using the biomarker, N-terminal pro-natriuretic peptide, and regular echocardiography is then required for diagnosis and follow-up. There is no direct medical therapy for CHD, but the focus of non-surgical care is to control CS symptoms, reduce tumour load and decrease hormone levels. Valve surgery improves long-term outcome for those with severe disease compared to medical management, although peri-operative mortality remains at between 10-20% in experienced centres. Therefore, care needs to be multidisciplinary at all stages, with clear discussion with the patient and between teams to ensure optimum outcome for these often-complex patients.

Item Type: Article
Additional Information: This article is available to all UHB staff and students via ASK Discovery tool http://tinyurl.com/z795c8c by using their UHB Athens login IDs
Subjects: WG Cardiovascular system. Cardiology
Divisions: Clinical Support > Anaesthetics
Clinical Support > Critical Care
Emergency Services > Cardiology
Emergency Services > Renal
Planned IP Care > Thoracic Surgery
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Depositing User: Mrs Yolande Brookes
Date Deposited: 22 Nov 2019 16:27
Last Modified: 22 Nov 2019 16:27
URI: http://www.repository.uhblibrary.co.uk/id/eprint/2610

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