Coronary Vasospasm and Bowel Ischemia in a Patient with Metastatic Gastrointestinal Carcinoid

We describe a case of a 60-year-old female with a history of metastatic carcinoid disease with liver involvement who developed coronary vasospasm and mesenteric ischemia. The carcinoid syndrome is known for its cardiac involvement most well characterized by fibrous tissue deposits on the endocardium.(1,2) Case reports of coronary artery vasospasm have been previously described and hypothesized to be mediated by vasoactive amines and polypeptides synthesized by the tumor.(3-9) Intestinal ischemia is another reported complication of the carcinoid syndrome and is hypothesized to have a similar mechanism to that of the coronary vasospasm.(10-17) We have reviewed the literature and describe a case of coronary vasospasm and mesenteric ischemia in a patient on octreotide therapy. This is the first case in which we have identified concurrent coronary vasospasm and mesenteric ischemia in a patient with carcinoid disease.