Chest
Selected ReportsCoronary Spasm and Cardiac Arrest From Carcinoid Crisis During Laser Bronchoscopy
Section snippets
Case Report
A 10-year-old girl presented with a 2-year history of progressive dyspnea on exercise and a recent episode of hemoptysis. She had been healthy and physically at par with her peers. She denied episodes of flushing nausea palpitations diarrhea or headaches. On exam breath sounds were diminished over the right chest and the apical impulse was displaced to the right parasternal border. The chest radiograph revealed opacification of the right hemithorax and a mediastinal shift to the same side.
Discussion
Acute carcinoid crisis can occur during FB. The carcinoid crisis usually involves the development of tachycardia flushing hypertension or hypotension.1 Coronary artery spasm is an unusual manifestation of an acute carcinoid syndrome and is not well recognized. Our patient presented with prolonged S-T segment elevation followed by ventricular tachycardia which is a characteristic of variant angina. Only two case reports have previously described coronary spasm with carcinoid syndrome.4,5 In a
Conclusion
Bronchoscopic manipulation of carcinoid tumors can cause a life-threatening carcinoid crisis. Coronary artery spasm is an uncommon presentation of the carcinoid syndrome and must be recognized by the clinician as the treatment approach to a carcinoid crisis differs from standard resuscitation protocols. Hypotension or cardiac arrest should be treated by aggressive volume replacement and intravenous somatostatin. Epinephrine should be avoided as it may paradoxically worsen the hypotension by
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Cited by (27)
Octreotide for resuscitation of cardiac arrest due to carcinoid crisis precipitated by novel peptide receptor radionuclide therapy (PRRT): A case report
2020, Journal of Critical CareCitation Excerpt :Risk factors for carcinoid syndrome include elevated 5-HIAA levels and high tumour burden. Although rare, cardiac arrest is a frequently fatal complication of carcinoid crisis, resulting from coronary spasm, profound vasodilation, and other unclear mechanisms [12-14]. There are numerous recommended treatment options for metastatic carcinoid tumours.
Gastroenteropancreatic neuroendocrine (carcinoid) tumors in children
2014, Seminars in Pediatric SurgeryCitation Excerpt :The cluster of symptoms and signs of carcinoid syndrome described above can be accompanied by right upper quadrant pain resulting from the local pressure of the hepatic metastases. “Carcinoid crisis” is an acute and severe form of carcinoid syndrome usually triggered by anesthetic induction or manual handling/manipulation of a functional NET tumor.23 Carcinoid crisis is extremely rare in children.
Management of cardiac arrest caused by coronary artery spasm: Epinephrine/adrenaline versus nitrates
2009, Heart and Lung: Journal of Acute and Critical CareCitation Excerpt :Therefore, sudden cardiac arrest, especially in previously fit patients, that occurs under circumstances as listed in Table I merits rethinking on how to use epinephrine/adrenaline or nitrates during CPR. In the case by Iida and coworkers,2 the administration of nitrates instead of epinephrine/adrenaline turned out to be the only effective treatment to reverse cardiac arrest in CAS. In our patient, isosorbide dinitrate successfully reversed CAS 4 minutes after the administration during CPR.
A most unusual acute coronary syndrome
2006, Canadian Journal of CardiologyRemifentanil and anaesthesia for carcinoid syndrome
2004, British Journal of AnaesthesiaCitation Excerpt :At an infusion rate of 0.15–0.2 μg kg–1 min–1, the haemodynamic variables were virtually unchanged in this patient. Other narcotics that have been used in the management of carcinoid syndrome include sufentanil and fentanyl.9 10 There is a risk that epidural anaesthesia could cause hypotension, triggering mediator release and a carcinoid crisis.11
Bronchial carcinoid tumor: Diagnosis by fiberoptic bronchoscopy
2001, Archivos de Bronconeumologia