Tricuspid Valve Regurgitation as a Presenting Symptom of Metastasized Carcinoid Tumor

A 66-year-old woman was diagnosed with hepatic metastasized carcinoid tumor of the ileocecal junction resulting in elevated plasma chromogranin A levels and urinary 5-hydroxyindoleacetic acid (5-HIAA) levels. Further examination showed right-sided heart failure with severe tricuspid valve regurgitation. Carcinoid tumors produce serotonin which leads to flushing, secretory diarrhea, bronchospasm and hypotension, known as carcinoid syndrome. Serotonin is metabolized to 5-HIAA, which is inactive, in the liver and the lungs. However, hepatic metastases may result in direct exposure of the heart to serotonin, which induces plaque-like deformities on the tricuspid valve, and in turn induces valve regurgitation. This condition is known as carcinoid heart disease. Tricuspid valve regurgitation may induce risk of massive blood loss in case of liver surgery through high-volume backflow in the hepatic veins. This report shows the clinical relevance of carcinoid heart disease in the perioperative setting

The value of clinical and laboratory diagnostics for chest pain patients at the emergency department

Background: The focus during the diagnostic process for patients with acute chest pain is to discriminate patients who can be safely discharged from those who are at risk for an acute coronary syndrome (ACS). In this study the diagnostic value of the clinical examination is compared with laboratory testing of troponin. Methods: This study included 710 chest pain patients who presented at the ED of two hospitals in the Netherlands. Clinical examination and laboratory testing were combined in the recently developed HEART-score. The diagnostic values of clinical presentation, troponin and the HEART-score for a major adverse coronary event (MACE) and an ACS within 6 weeks were assessed. Furthermore, the improvement of HEART with the second troponin measurement after 6 h was assessed using the net reclassification improvement (NRI). Results: The use of HEART (AUC(MACE) : 0.77; AUC(ACS) : 0.82) obtains a higher diagnostic value than troponin (AUC(MACE) : 0.72; AUC(ACS) : 0.74) or clinical evaluation (AUC(MACE) : 0.69; AUC(ACS) : 0.74). Statistical significant different AUCs were obtained when HEART is compared to troponin or clinical evaluation (p <0.01). The use of the second troponin test (after 6 h of admission) within HEART resulted in an improvement of 8.0%. Conclusions: The HEART-score combines clinical evaluation and results from laboratory testing, which should be used together, to discriminate patients at risk of a cardiac event from patients who can be safely discharged. In addition, it is shown that a second troponin measurement slightly improves the discriminative ability of the HEART-score

Alirocumab and cardiovascular outcomes after acute coronary syndrome

BACKGROUN

Alirocumab and Cardiovascular Outcomes after Acute Coronary Syndrome

BACKGROUN