key: cord-0756019-wnujpf6e
authors: Bell, Jennifer; Alhudairy, Maad; Kazakova, Vera; Johnstone, Michael; Tsao, Lana
title: Right and Left-Sided Carcinoid Heart Disease in the Setting of Selective Serotonin Reuptake Inhibitor Use
date: 2020-10-21
journal: JACC Case Rep
DOI: 10.1016/j.jaccas.2020.07.060
sha: 8bcd59cfbabc563a4da14606a5451efd5cf23f67
doc_id: 756019
cord_uid: wnujpf6e

Carcinoid heart disease is a complication of carcinoid syndrome. The role of selective serotonin reuptake inhibitors in carcinoid heart disease is unclear. We present a case of refractory heart failure due to right- and left-sided carcinoid heart disease in the setting of selective serotonin reuptake inhibitor use despite remission of carcinoid syndrome. (Level of Difficulty: Beginner.)

afebrile with a blood pressure of 92/60 mm Hg, a heart rate of 103 beats/min, and oxygen saturation of 94% on room air. Her physical exam findings were suggestive of volume overload, including jugular venous distension, bilateral lung crackles, hepatomegaly, and lower-extremity edema.

Her past medical history was notable for a malignant carcinoid tumor with mesenteric metastasis in 2009, which was resected and treated with monthly octreotide injections. In June 2017, she was deemed to be in remission based on laboratory and imaging studies; therefore, octreotide was discontinued. In early 2018, she suffered multiple major depressive episodes with psychosis and was started on the selective serotonin reuptake inhibitor (SSRI) citalopram with gradual dose up-titration over the course of several months. Six months later, she developed flushing, diarrhea, and progressively worsening dyspnea on exertion requiring multiple hospitalizations.

The differential diagnosis for heart failure exacerbation included coronary ischemia, valvular heart

To understand the pathophysiology of carcinoid heart disease. To discuss the role selective serotonin reuptake inhibitors may play in the development of valvular heart disease. To emphasize the significant mortality associated with carcinoid heart disease. To discuss a potential mechanism for selective serotonin reuptake inhibitor-induced carcinoid heart disease late after carcinoid tumor therapy. 

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