A 60-year-old woman with a history of ileal carcinoid tumor presents with progressive dyspnea and right heart failure. Cardiac exam reveals a loud P2, parasternal lift, and a holosystolic murmur at the left sternal border increasing with inspiration. Echo shows thickened, retracted tricuspid valve leaflets with restricted motion and severe tricuspid regurgitation. Which additional finding is most characteristic of carcinoid heart disease?

• A Plaques in the left ventricular outflow tract
• B Aortic stenosis with calcification
• C Mitral valve prolapse with myxomatous degeneration
• D Pulmonary valve involvement with stenosis or regurgitation ✓

Explanation

Carcinoid heart disease characteristically affects right-sided valves (tricuspid and pulmonary) due to inactivation of serotonin and vasoactive substances by the lungs. Pulmonary valve involvement (stenosis or regurgitation) is present in the majority of cases alongside tricuspid regurgitation. Left-sided involvement is rare and occurs only with right-to-left shunts or bronchial carcinoid.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

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Written and medically reviewed by the StethoPrep medical team.