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The diagnosis and prognosis of carcinoid heart disease have largely been based on the biochemical burden of the disease. Clinical and radiological factors, however, are not as useful as biochemical burden. This article will explore the pathophysiology of carcinoid heart disease. Read on to learn more. We also have information on treatment and the prognosis of this disease. We hope that this article will be helpful to you and your doctor.
Pathophysiology
There are many variables associated with the pathophysiology of carcinoid heart failure. Although the diagnosis is often made without cardiac involvement, patients with this type of disease still may have symptoms. The prognosis of this condition is generally poor. Pathophysiology of carcinoid heart failure includes the diagnosis, symptoms, and treatment of the disease. Several different treatments may be necessary to alleviate the symptoms of this condition.
The primary symptoms of carcinoid heart disease include breathlessness, ascites, swollen ankles, and fatigue. Patients may also present with pulmononic regurgitation, heart failure, and left-sided pulmonary metastasis. Most patients with carcinoid heart disease present with right-sided disease because of lung inactivation. Approximately 10% of patients with CHD develop left-sided heart involvement, usually due to lung metastasis and a right-to-left shunt. Serotonin levels may be elevated in these patients. Pulmononic regurgitation, pulmonary stenosis, and right-to-left shunt may also occur.
The presence of carcinoid heart disease may be the first sign of the syndrome in patients with carcinoid heart disease. This disease is the most common cause of morbidity and mortality in patients with carcinoid syndrome. The disease is characterized by pathognomonic plaque-like deposits of fibrous tissue in the endocardium and valvular cusps. Some patients also exhibit increased cardiac output.
Surgery for the tumour may improve the symptoms and reduce the risk of a carcinoid heart disease. Treatment of carcinoid heart disease is generally successful and will produce a cure. Surgery for the tumour, however, should be a last resort and be undertaken only when it’s absolutely necessary. In some cases, a patient may develop carcinoid heart disease after the surgery. If surgery does not relieve the symptoms, a carcinoid heart disease may develop after treatment for the tumour. However, this condition can be fatal.
Diagnosis
Patients with carcinoid heart disease have the characteristic thickening and retraction of the tricuspid valve, and pulmonary valve retraction. Myocardial metastases are also present. Right ventricular size and systolic function are measured semiquantitatively, and tricuspid regurgitation is assessed visually and with Doppler imaging of the transtricuspid inflow.
Diagnosis of carcinoid cardiomyopathy should include a thorough physical examination. Right ventricular size and advanced NYHA class are two factors that are predictive of mortality in carcinoid heart disease. In addition, if you’re experiencing a history of high-risk factors, you should be screened for carcinoid heart disease. The symptoms of this disease can be subtle and can be missed by a patient.
The participants were divided into three groups based on the date of their first carcinoid heart disease diagnosis. Patients diagnosed in 1981 through June 1989 were classified as group A. Patients diagnosed from July 1989 to May 1995 were classified in group B. Finally, patients diagnosed in 2000 were classified into group C.
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The progression of carcinoid heart disease is largely dependent on the hormones and biochemical burden of the disease. Surgical treatment can suppress the secretion of vasoactive substances, such as somatostatin analogues, while the resection of the primary tumour may protect patients from the progression of the disease. Diagnosis of carcinoid heart disease continues to be challenging, but advances in diagnostic procedures have made it possible to detect cardiac carcinoid disease and monitor its progression. The use of appropriate medications and surgical intervention may be the best treatment option for patients. Furthermore, ongoing clinical trials may reveal additional improvements to diagnosis.
Among those with carcinoid heart disease, only about 10% of patients will have cardiac surgery. However, there are some patients who undergo surgery despite the asymptomatic nature of the disease. In group A, cardiac surgery is recommended for patients with advanced valvular dysfunction, but there are other treatment options. A pulmonary valve lesion may require valvulotomy or valvectomy. Surgical treatments may include percutaneous valve implantation.
Treatment
The prognosis of patients with carcinoid heart disease is not clear. Generally, the disease is more serious when the underlying tumor is a solid one. Patients who have moderate to severe right ventricular dilatation and New York Heart Association class III-IV symptoms are considered to be at increased risk. Screening patients may identify patients who have this condition and may be more susceptible to the disease’s complications.
The first step in carcinoid heart disease treatment is a high index of clinical suspicion. Patients with this condition typically begin displaying symptoms between the fifth and seventh decade of life, usually between 55 and 60 years. However, the time between the onset of symptoms and diagnosis can vary from 24 to 28 months to five years. Treatment can include surgical intervention or medication. Currently, monoclonal antibodies are being tested as a treatment option.
Currently, the standard treatment for patients with carcinoid heart disease is long-acting formulations of somatostatin analogues. Taking this drug for several years can delay the progression of the disease. Fortunately, somatostatin analogues and cardiac surgery have improved the prognosis of carcinoid heart disease. However, patients must seek medical advice from a doctor who specializes in heart surgery.
Patients with carcinoid heart disease are evaluated in a multidisciplinary Carcinoid Heart Disease Clinic. The clinic examines the extent of the heart disease and the involvement of the cardiac valve. The team will then decide on the best course of treatment for the patient’s condition. There are several interventions available, including medications that control the growth of tumor cells. But they are not the only interventions available for patients with carcinoid heart disease.
Researchers have shown that patients who undergo valve replacement surgery have increased survival rates for carcinoid heart disease, possibly related to the procedure. In addition to this procedure, more than one hundred patients have been treated with multidisciplinary care at the clinic. These results have helped the patients’ overall survival.
Prognosis
In patients with carcinoid syndrome, the prognosis for a full recovery from heart failure is excellent. Surgery can reduce symptoms of heart failure and improve the prognosis. In one study, postoperative mortality was related to the progression of cardiac involvement, not to the complications of surgery. More than half of the patients with carcinoid heart disease also had cardiac involvement, either in the form of valvular dysfunction or cardiac metastases.
A recent study enrolled 66 patients with carcinoid heart disease from July 1989 to May 1995 and from June 1995 to 2000. Researchers reviewed the patients’ medical charts and recorded their NYHA classes at the time of diagnosis and immediately before cardiac surgery. The patients were also evaluated for the use of serotonin reuptake inhibitors and ergot alkaloid. These findings support the findings that treatment with somatostatin analogues improves the prognosis of carcinoid heart disease.
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Diagnosis of carcinoid heart is based on the presence of symptoms like dyspnea and fatigue. A patient’s pro-brain natriuretic peptide (NT-proBNP) level will be elevated. Chest X-rays will often be normal, but may show pleural effusion or cardiac enlargement. Cardiovascular magnetic resonance imaging may be performed to evaluate valvular regurgitation or spondylar or mitral valve dysfunction.
In a recent study, researchers followed 80 patients with carcinoid syndrome for 26 months. Twenty percent of the patients developed carcinoid heart disease during the study period. Despite the low proportion of patients who developed the disease during the study period, there are no definitive markers to determine the exact course of the disease. However, the researchers found that biochemical markers of the disease are more useful than radiological or clinical markers.
The survival time for patients with carcinoid heart disease varies from one to four years after diagnosis. Most studies focused on patients who underwent surgery between 1980 and 1990. Since then, somatostatin analogues, hepatic artery dearterialization, and heart valve replacement have been widely used. The main aim of this study is to determine the prognosis for patients with metastatic carcinoid disease, regardless of the site of the tumor.
