Abstract
A72-year-oldgentlemanpresentedwith signsof right heart failure. Echocardiogram showed severe tricuspid regurgitation with thickened tricuspid leaflets. He was subsequently diagnosed with metastatic carcinoid tumour. Carcinoid heart disease (CHD) is the initial presentation of carcinoid tumours in up to 20% of patients, with triscuspid regurgitation the most common cardiac manifestation. Clinicians need a high index of suspicion to recognise CHD as this heralds a decline in clinical outcome. CHD has a 31% three year survival rate, half that of patients without CHD. Echocardiographyprovides diagnostic andprognostic utility. Thickening of the tricuspid valve leaflets and sub-valvular apparatus leads to incomplete coaptation and regurgitation. The continuous wave Doppler profile of tricuspid regurgitation shows a characteristic dagger shaped spectrum with an early peak pressure and rapid decline. Pulmonary stenosis should be sought as this may exacerbate right heart failure.
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