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Metastatic Carcinoid Disease Presenting Solely as High-Output Heart Failure

Douglas Yun, MD; and J. Thomas Heywood, MD
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From Loma Linda Jerry L. Pettis Memorial Veterans Hospital and Loma Linda University Medical Center, Loma Linda, California. Requests for Reprints: J. Thomas Heywood, MD, Cardiology Section, Loma Linda Jerry L. Pettis Memorial Veterans Hospital, 11201 Benton Street, Loma Linda, CA 92357. Acknowledgments: The authors thank Dr. O'Dorisio and his staff at The Ohio State University Hospital Laboratory for their analysis of the serum sample for substance P.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1994;120(1):45-46. doi:10.7326/0003-4819-120-1-199401010-00008
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Metastatic carcinoid disease can result in congestive heart failure by causing progressive endocardial fibrosis of right-sided chambers and valves. We report an unusual case of metastatic carcinoid disease with high-output heart failure without the typical features of cutaneous flushing and valvular lesions. The patient's urine level of 5-HIAA was only mildly elevated, but substance P, a powerful vasodilator, was markedly elevated. In this patient, high-output congestive heart failure was the sole manifestation of a carcinoid tumor producing substance P.

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