Carcinoid Heart Disease
Carcinoid Heart Disease
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DOI：
10.1177/003591577406700501
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发表时间：
1974-05
影响因子：
17.3
通讯作者：
S. H. Dave;E. C. B. Keat
中科院分区：
文献类型：
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作者：
S. H. Dave;E. C. B. Keat
GP夫人，64岁病史：1973年5月，她因左脚肿胀和左小腿疼痛而入院，随后双腿肿胀，体重增加。她注意到脸发红，特别是在用力，弯腰和喝酒时。她的大便有拉肚子的趋势。7年前（1966年7月），通过右半结肠切除术从回盲部切除肿瘤。手术后病理诊断为类癌，并发现邻近腺体浸润。检查时：面部明显潮红，双腿肿胀，骶部有些水肿。颈静脉压升高，伴收缩波，心尖搏动向外侧移位。没有震颤，但有明显的全收缩期杂音和短的舒张期杂音，符合三尖瓣疾病。肝脏可触及且有搏动。检查：胸部X线检查：一些全身性心脏肥大，但肺野清晰。ECG：低电压，窦性心律。尿5 HIAA 47 mg/天（正常值10 mg/天）。血尿素和电解质正常。肝功能检查正常。心音图描记如图1所示。治疗：使用地高辛和利尿剂成功治疗充血性心力衰竭，患者情况良好。到目前为止，腹泻和潮红不需要任何治疗。
Mrs G P, aged 64 History: In May 1973 she was admitted to hospital with swelling of the left foot and some pain in the left calf, followed by swelling of both legs, and weight gain. She had noticed flushing of the face, particularly on exertion, bending and taking alcohol. Her bowels tended to be loose. Seven years previously (in July 1966) a tumour was removed from the ileoc=ecal region by right hemicolectomy. A histological diagnosis of carcinoid was made following operation, and adjoining glands found to be infiltrated. On examination: Marked flushing of face, swelling of both legs, some sacral cedema. Jugular venous pressure was raised, with systolic waves, and the apex beat was displaced laterally. There was no thrill, but a prominent pansystolic murmur and short diastolic murmur compatible with tricuspid valve disease. Liver palpable and pulsatile. Investigations: Chest X-ray: some generalized cardiomegaly but lung fields clear. ECG: low voltage, sinus rhythm. Urinary 5HIAA 47 mg/ day (normal 10 mg/day). Blood urea and electrolytes normal. Liver function tests normal. Phonocardiogram tracing is shown in Fig 1. Treatment: The congestive heart failure was treated successfully with digoxin and diuretics, and the patient remains well. Diarrhoea and flushing have not required any treatment so far.