Case of the month #166: carcinoid heart disease. Carcinoid syndrome.

A previously healthy 60-year-old woman presented with a 3-week history of fatigue and exertional dyspnea. Over the past year, she had experienced episodic wheezing, facial flushing, diarrhoea, and an unintentional 40-lb weight loss. On physical examination, she demonstrated venous telangiectasia in the malar region, mild peripheral cyanosis, and an elevated jugular venous pressure with a dominant V wave. On cardiac auscultation, there was a holosystolic murmur at the left lower sternal region of grade III/VI intensity that increased on inspiration. Transthoracic echocardiography was performed to confirm the valvular abnormalities detected on physical examination (Figure 1A). Cardiac magnetic resonance imaging (CMR) was performed to quantify right ventricular systolic function and computed tomography of the abdomen was performed as shown Figures 1B and C.