A most unusual acute coronary syndrome

Area of Science:

• Cardiology
• Oncology
• Gastroenterology

Background:

• A 60-year-old man with coronary artery disease presented with unstable angina, dyspnea, flushing, diarrhea, and weight loss.
• Initial investigations revealed coronary artery stenosis and a patent foramen ovale.

Observation:

• The patient developed recurrent chest pain and in-stent thrombosis after angioplasty and stenting.
• Coronary angiography suggested vasospasm in multiple coronary arteries.

Findings:

• A diagnosis of vasospastic angina was made, attributed to serotonin secreted by a carcinoid tumor.
• The patent foramen ovale facilitated direct shunting of serotonin to the coronary arteries, bypassing pulmonary metabolism.

Implications:

• This case highlights a rare presentation of carcinoid syndrome manifesting as vasospastic angina and acute coronary syndrome.
• It underscores the importance of considering carcinoid disease in patients with unexplained coronary vasospasm and cardiac events.
• Effective management involved high-dose calcium channel blockers after initial interventions failed.