Carcinoid heart disease

• Rare cardiac manifestation of advanced neuroendocrine tumours
• Carcinoid syndrome occurs when the tumour metastasizes to liver where it produces excess hormones e.g. 5HIAA, serotonin, histamine etc.
• Carcinoid syndrome produces right sided cardiac valve disease → carcinoid heart disease

Primary cardiac tumours

• Primary tumours in the heart are very rare - cardiac muscle cells are end differentiated

Atrial myxoma

• Atrial myxoma is the most common primary tumour of the heart (but still very rare)
• Benign and composed of unspecialised mesenchymal cells within a mucopolysaccharide stroma causing a smooth, gelatinous appearance
• Occur more commonly in women than in men

Clinical features

• Frequently cause constitutional symptoms such as weight loss and fatigue
• Cardiac symptoms are primarily related to their location within the heart, which is most commonly the left atrium
  • Left atrial tumours can cause left atrial dilatation with increased pulmonary vascular pressures and systemic embolic phenomena (e.g. clubbing)

Investigations

• Bloods: raised inflammatory markers
• Echocardiogram: mobile mass in the left atrium
• Cardiac MRI

Management

• Surgical resection
• Once resected tumour recurrence is rare