Carcinoid heart disease in a patient with a neuroedocrine tumor of the gastrointestinal tract. Where to begin?

Abstract

Carcinoid heart disease (CHD) is one of the complications that occurs in patients with widespread neuroendocrine tumors as a consequence of the course of carcinoid syndrome. CHD most often develops when the primary tumor is localized in the small intestine, as well as in the lungs, colon, pancreas, appendix and ovaries. Carcinoid syndrome is a paraneoplastic manifestation that develops as a result of the release of serotonin and other vasoactive substances by the tumor into the bloodstream. It is accompanied by a spectrum of symptoms such as diarrhea, flushes, bronchospasm and symptoms of congestive heart failure. Without specific therapy, patients with severe heart failure against the background of CHD have an extremely negative prognosis for life, with an expected overall survival of no more than one year. Treatment of this pathology is often difficult, since patients usually seek treatment late, while the disease can progress rapidly. Thus, optimal management of this group of patients requires close collaboration between physicians from various specialties, including hepatobiliary and cardiovascular surgeons, endocrinologists, anesthesiologists and gastroenterologists, to select the most effective treatment strategies depending on the severity of heart failure in order to improve quality of life and reduce mortality.