A 50-year-old woman with metastatic carcinoid tumor and elevated serum serotonin develops edema and hepatomegaly. Echocardiography shows tricuspid regurgitation and pulmonary stenosis. The characteristic valvular lesion is:
- A Fibrous endocardial plaques on the ventricular aspects of the tricuspid and pulmonary valves ✓
- B Commissural fusion with leaflet shortening of the mitral valve
- C Large friable vegetations containing bacteria on the atrial surfaces
- D Myxomatous thickening with redundant leaflets and elongated chordae
Correct answer: A. Fibrous endocardial plaques on the ventricular aspects of the tricuspid and pulmonary valves
Explanation
Carcinoid heart disease affects predominantly right-sided valves because serotonin and other vasoactive products released by hepatic metastases reach the right heart directly and are degraded in the lungs. Grossly there are fibrous plaques on the endocardium and on the ventricular aspect of the tricuspid and pulmonary valves, causing regurgitation and stenosis respectively. Left-sided involvement requires a patent foramen ovale or bronchial carcinoid. The other options describe rheumatic, infective, and myxomatous disease.
Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.