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Coronary vasospasm associated with uncontrolled carcinoid tumour
1Division of Internal Medicine, Department of Cardiology, Hadassah University Hospital, Jerusalem, Israel.
Journal of Internal Medicine
|February 26, 2000
Summary
A carcinoid patient experienced chest pain and ECG changes due to incorrect octreotide dosage. Correcting the medication resolved symptoms, suggesting carcinoid syndrome triggered coronary vasospasm.
Area of Science:
- Cardiology
- Endocrinology
- Oncology
Background:
- Carcinoid syndrome can manifest with diverse symptoms, including cardiovascular events.
- Myocardial infarction (MI) and percutaneous transluminal coronary angioplasty are significant cardiac events.
- Octreotide is a somatostatin analog used to manage carcinoid syndrome symptoms.
Observation:
- A 74-year-old patient with carcinoid syndrome presented with recurrent chest pain and ST-segment elevation post-MI.
- Elevated urinary 5-hydroxy-indole acetic acid levels correlated with symptom recurrence.
- The patient inadvertently received a reduced octreotide dosage for three weeks prior to MI.
Findings:
- Correction of the octreotide dosage led to immediate resolution of chest pain episodes.
- The findings suggest a link between suboptimal carcinoid tumor control and coronary vasospasm.
- Recurrent coronary vasospasm was attributed to uncontrolled carcinoid syndrome.
Implications:
- This case highlights the importance of accurate octreotide dosing in managing carcinoid syndrome.
- Suboptimal treatment may precipitate cardiovascular complications like coronary vasospasm.
- Clinicians should consider carcinoid syndrome in patients with unexplained coronary vasospasm, especially after cardiac events.