Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0018801 (heart failure)
 72,216 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Carcinoid heart disease is a complication of a neuroendocrine carcinoid tumor. Morphologically, it is characterized by the formation of fibrotic plaques with deposition of extracellular matrix in the subendocardium, frequently causing heart valve dysfunction and cardiac failure. Because members of the transforming growth factor-beta (TGF-beta) family are known to stimulate fibroblasts in their production of extracellular matrix, we investigated the expression of the three isoforms of TGF-beta and the binding protein for latent TGF-beta 1 (LTBP) in carcinoid plaques of the right side of the heart, as well as from control tissue, using immunohistochemistry. Tissue specimens were obtained intraoperatively from nine consecutive patients undergoing valve replacement surgery. TGF-beta 1 and TGF-beta 3 were detected in the fibroblasts of all plaques analyzed, whereas TGF-beta 2 was only rarely expressed. The localization of LTBP was partly concordant with that of TGF-beta 1, but the positive staining for LTBP was extracellular. Sections from unaffected heart tissue contained few fibroblasts in the subendocardium, showing only weak or no immunostaining for TGF-beta 1, -beta 2, and -beta 3 and no staining for LTBP. These results suggest that TGF-beta may play a role in the proliferation of fibroblasts and their matrix production in carcinoid heart lesions.
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PMID:Involvement of transforming growth factor-beta in the formation of fibrotic lesions in carcinoid heart disease. 842 67

The clinicopathologic features of a patient with primary carcinoid tumor of the ovary who presented with the signs of cardiac failure are described. The patient underwent total abdominal hysterectomy + bilateral salpingo-oophorectomy + omentectomy + bilateral pelvic lymphadenectomy + appendectomy; and she is alive with no evidence of recurrent disease one year after surgery.
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PMID:Primary carcinoid tumor of the ovary. A case report. 847 30

A case of successful tricuspid valve replacement with a mechanical prosthesis and pulmonary valvulotomy for carcinoid heart disease is reported. The patient was a 61 years old women. The primary tumor was in the terminal ileum. Liver metastasis and carcinoid syndrome were present since 8 years. After cardiac surgery, the patient survived 38 months and late death was related to disseminated metastasis. Even in case of metastasis, carcinoid tumor is slow growing. Without cardiac operation for correction of valvular lesions, terminal symptoms and death may often be related to cardiac operation for correction of valvular lesions, terminal symptoms and death may often be related to cardiac failure rather than to tumoral growth. Thus, even in presence of metastasis, cardiac surgery may be mandatory to improve both quality of life and survival.
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PMID:Successful tricuspid valve replacement and pulmonary valvulotomy for carcinoid heart disease. 883 Aug 75

Carcinoid tumours in the intestine are slowly growing neuroendocrine tumours. Patients as a rule report symptoms of the carcinoid syndrome: attacks of diarrhoea and of flushing. When the earliest symptoms manifest themselves, metastases are already present, virtually always localized in the liver. At a late stage, heart failure may occur, difficult to treat and caused by fibrosis of the tricuspid valve in the presence of protractedly raised blood serotonin levels. To diagnose carcinoid tumours, use is made of radioactive substances binding to hormone receptors such as 131I-MIBG and 111-In-octreotide. When multiple metastases exist, only palliative treatment is possible. The drugs used are the somatostatin analog octreotide, interferon alpha, radioactive MIBG and non-radioactive MIBG; these drugs may also be used in combination. The therapies mentioned have approximately the same effect: symptoms improve in 60-80%, while 30-50% show a biochemical response, i.e. decrease of the number of breakdown products in the urine of the hormones produced by the tumour; tumour size decreases in 0-12%.
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PMID:[Carcinoid tumors of the intestines: developments in the Netherlands for diagnosis and palliative treatment]. 1022 Nov 20

Cardiovascular emergencies in oncology patients include all of the usual cardiac problems, as well as complications of cancer and its therapy. Pericardial effusions and tamponade, cardiac masses, and extrinsic compression of the heart and great vessels by tumor masses, or fluid collections may all occur. Certain tumors may secrete mediators that are directly toxic to the heart; for example, catecholamines are secreted by pheochromocytomas and serotonin is secreted by carcinoid tumors. Tumors can also cause arrhythmias due to the mediators they secret or to direct mechanical irritation of the heart or pericardium. Cancer therapy is also associated with cardiac emergencies. Perioperative myocardial ischemia or infarction, as well as arrhythmias, may complicate surgery. Pericardial effusions and tamponade can follow surgery, radiation, or chemotherapy. Chemotherapy with anthracyclines, mitoxantrone, and trastuzumab may prompt acute and chronic heart failure. 5-Fluorouracil causes coronary spasm in some patients, leading to angina, myocardial infarction, arrhythmias, and/or sudden death. Cyclophosphamide, particularly in high doses, may produce acute myopericarditis. Radiation may cause acute pericardial disease and late sequelae such as myocardial infarction, acute valvular insufficiency, or effusive constrictive pericarditis. Endocarditis also occurs in cancer patients in association with vascular access devices and immune compromise. This review will discuss each of these complications of cancer and its therapy.
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PMID:Cardiovascular emergencies in the cancer patient. 1086 14

We describe a patient with carcinoid heart disease secondary to a primary ovarian carcinoid tumor who initially presented with unexplained right-sided heart failure. The patient did not exhibit any of the typical clinical manifestations of the carcinoid syndrome. Echocardiography demonstrated typical features of carcinoid heart disease and played an important role in the detection and management of a condition that was previously unrecognized.
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PMID:Carcinoid heart disease in association with a primary ovarian carcinoid tumor: diagnostic role of echocardiography. 1100 May 93

A 57-year-old female patient with known cardiac disease developed a 4 to 6 week history of diarrhea, followed by onset of orthopnea and subsequent right-sided cardiac failure. On hospital admission she was found to have pure tricuspid regurgitation, without evidence of cardiac ischemia, pulmonary embolism, bacterial endocarditis or pericardial disease. A 24-hour urine collection for 5-HIAA was elevated, and a subsequent octreotide scan documented abnormal uptake in the pelvic cul-de-sac. Bilateral ovarian masses were found at laparotomy, which on pathological examination were found to be a benign left ovarian cystic teratoma, and a right carcinoid tumor of the ovary. This patient presented with systemic complaints of diarrhea, and orthopnea and right sided heart failure that on evaluation were ultimately found to be due to a unilateral primary carcinoid tumor of the ovary, which accounts for less than 0.1% of all ovarian carcinomas, and only 5% of all carcinoids. Treatment of this malignant carcinoid syndrome presentation consisted of debulking of the tumor and continuation of her diuretics and digoxin. Diarrhea and orthopnea ceased within 2 weeks after her oophorectomy. On evaluation 6 weeks and 6 months postoperatively, her cardiac function was stable, though unchanged. 5-HIAA levels were within normal limits, demonstrating the curative function of surgery in patients with unilateral ovarian carcinoid without evidence of metastases, as well as preserved cardiac function in otherwise stable patients.
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PMID:A case of diarrhea and orthopnea in a 57-year-old female. 1106 Oct 23

Carcinoid syndrome originates from metastatic carcinoid tumors localized in the gastrointestinal system, pancreas, biliary vessels, bronchi, ovaries, and testes; it is characterized by flushing, telangiectasias, diarrhea, bronchoconstriction, and fibrous endocardial plaques in the heart. Cardiac involvement is detected by echocardiography in over 50% of patients with this syndrome. Right-sided valvular heart disease occurs frequently in patients with carcinoid syndrome, involving most commonly the tricuspid and pulmonary valves. Involvement of the left-sided valves rarely occurs. Medical therapy for carcinoid heart disease includes digitalis and diuretics for congestive heart failure symptoms; the effects of carcinoid syndrome can be treated with the use of somatostatin analogues. Conventional chemotherapy has been of little beneficial value, with response rates of only 10% to 30%. The use of octreotide, a long-acting and potent somatostatin analogue, is a major advance in the management of carcinoid tumors. In addition to providing effective symptom relief in malignant carcinoid syndrome, octreotide can also be used for diagnostic purposes. Despite its expense, octreotide is the current agent of choice for the treatment of this condition. Analogues with different receptor specificities and pharmacokinetics hold promise for the future. Valve surgery is the only definitive treatment for intractable right-sided heart failure. Although cardiac surgery carries high perioperative mortality, marked symptomatic improvement occurs in survivors. Surgical intervention therefore should be considered in the appropriate patients when cardiac symptoms become severe. Balloon valvulotomy in patients with severe pulmonary artery stenosis often results in palliation of symptoms; however, surgery still is required often in these patients.
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PMID:Carcinoid Heart Disease. 1109 44

The use of helical CT, infusing pump and non-ionic contrast media has enabled the evaluation of different hepatic circulatory phases during contrast injection. Starting the acquisition of scans 20 to 30 seconds after the injection at a rate of 3 to 4 ml/sec the arterial enhancing of the liver is depicted. THROMBOSIS OR COMPRESSION OF THE PORTAL VEIN: Hypervascular triangle-shaped was with peripheral base can be seen, secondary to the increased arterial flow to compensate for the diminished portal flow. ARTERIOPORTAL SHUNTS: This condition can be caused by tumors such hepatocellular adenocarcinomas and hemangiomas, trauma, interventional procedures, cirrhosis, AVMs and surgery. INFLAMMATORY LESIONS: Hypervascular areas can be seen during the arterial phase in abscesses or cholecystitis, returning to their normal condition in the arterial phase. ANATOMIC VARIANTS: Third veins coming from the periphery (capsular veins, accessory cystic vein and an aberrant gastric vein) supply enhanced blood earlier than the portal circulation. OTHER CAUSES: In liver cirrhosis diffuse hyperattenuated areas can be seen during the arterial circulation. In right-sided heart failure, pericardial disease and Budd-Chiari Syndrome, "mosaic areas" can also be noted. In other patients these perfusion disorders were considered unknown. TUMORS: The well-differentiated hepatocellular carcinoma is a lesion with a predominant arterial blood supply, thus appearing in general hyperdense in this phase. Hemangiomas may appear as highly hyperdense lesions in the arterial phase and can be misinterpreted as HCC if smaller than 2 cm. (30% of cases). Focal nodular hyperplasia is a benign lesion (vascular malformation associated with focal nodules of hepatocellular hyperplasia) with increased arterial blood supply. Hepatic adenomas show an important hypervascularity during the arterial phase and, if large, they may present a small central scar and or capsule. Low or high-grade dysplastic nodules can sometimes be seen as hypervascular areas during the arterial phase. Although most metastasis are depicted as hypodense lesions sometimes they can show arterial hypervascularity such as carcinoid and pancreatic islet cell metastasis.
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PMID:[Liver hyperdensity during arterial phase on CT exams]. 1147 23

Carcinoid heart disease occurs in about one third of patients with carcinoid syndrome, especially in those with ileal carcinoid and hepatic metastases. Patients with primary ovarian carcinoid tumor are extremely rare. In these circumstances, typical carcinoid cardiac lesions may develop unassociated with hepatic metastases, due to the venous drainage from the ovaries into the inferior vena cava of vasoactive released substances such as serotonin. The present report describes a woman with unrecognized primary ovarian carcinoid tumor, unexpectedly exhibiting heart failure. Diagnosis was performed on the basis of echocardiographic findings, occurrence of diarrhea and increased levels of 5-hydroxy-indoleacetic acid (5-HIAA). After complete surgical removal of the tumor, the patient was maintained under therapy with ACE-inhibitors and diuretics. Levels of 5-HIAA are still within normal range, there is regression of heart failure and echocardiographic findings are stabilized. These data confirm the importance of prompt diagnosis for a favorable prognosis of carcinoid heart disease.
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PMID:[Carcinoid heart disease and primary ovarian tumor]. 1202 91


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