Carcinoid Heart Disease Presenting as Cardiogenic Shock: A Case Report

Carcinoid heart disease (CHD) is a complication of carcinoid syndrome that results from chronic exposure of the endocardium to circulating vasoactive substances, particularly serotonin. It leads to progressive right-sided valvular dysfunction and right heart failure. Presentation as cardiogenic shock is uncommon and may delay recognition of the underlying disease. We present the case of a 44-year-old woman with no prior medical history who developed progressive dyspnea, ascites, and lower extremity edema over four months and was admitted with cardiogenic shock. Transthoracic echocardiography revealed massive tricuspid regurgitation and moderate-to severe pulmonary regurgitation with marked right ventricular dilation with preserved conventional systolic indices. Abdominal imaging demonstrated hepatomegaly with multiple hypervascular hepatic lesions, and liver biopsy confirmed metastatic neuroendocrine tumor. Urinary 5-hydroxyindoleacetic acid was markedly elevated at 305 mg/24 hours with pro-B-type natriuretic peptide (pro-BNP) at 2,450 pg/mL, supporting the diagnosis of carcinoid syndrome with cardiac involvement. Lanreotide was initiated for biochemical and symptomatic control of the underlying carcinoid syndrome. Despite intensive hemodynamic support with inotropic and vasopressor therapy, the patient developed refractory cardiogenic shock and died from progressive right-sided heart failure. This case highlights an unusual and aggressive presentation of carcinoid disease manifesting as cardiogenic shock. Clinicians should maintain a high index of suspicion for CHD in patients with unexplained right-sided valvular dysfunction and systemic congestion, as early recognition may allow timely therapeutic intervention.