Carcinoid Heart Disease: A Comprehensive Review and Update on Pathophysiology, Diagnosis, and Management

Abstract

Carcinoid Heart Disease (CaHD) is a severe complication arising in patients with carcinoid syndrome, primarily impacting the heart’s right side through valvular dysfunctions such as tricuspid regurgitation and pulmonary stenosis. The pathology is closely linked to serotonin-induced fibrosis, challenging both diagnosis and treatment. Advances in echocardiography and cardiac MRI have significantly improved the early detection and assessment of CaHD, while management strategies have evolved to include both medical treatments, like somatostatin analogues and novel pharmacotherapies, and surgical interventions, notably valve replacement surgeries. Despite progress, debates persist around the optimal timing for surgery and the choice between bioprosthetic and mechanical valves, given the distinct risks and benefits of each. This review synthesises the current understanding of CaHD, emphasising diagnostic advancements and the spectrum of treatment options, and advocates for ongoing research to refine therapeutic approaches.