From the Guidelines
Yes, carcinoid syndrome can cause tachycardia. Carcinoid syndrome occurs when a carcinoid tumor, typically in the digestive tract, releases excessive amounts of vasoactive substances, particularly serotonin, into the bloodstream. These substances can trigger various cardiovascular effects, including tachycardia (rapid heart rate exceeding 100 beats per minute). The mechanism involves serotonin and other hormones like histamine and bradykinin stimulating the heart directly or causing vasodilation, which leads to a compensatory increase in heart rate.
Tachycardia may occur during carcinoid crisis, an acute, severe episode of carcinoid syndrome symptoms, or as a chronic symptom. Patients with carcinoid syndrome experiencing persistent tachycardia should seek medical attention, as management typically involves treating the underlying tumor and using somatostatin analogs like octreotide to block the release of these vasoactive substances. In acute situations, octreotide may be administered at 50-100 mcg intravenously to manage symptoms including tachycardia, as supported by studies such as the PROMID study 1.
Some key points to consider in the management of carcinoid syndrome and its effects on the heart include:
- The frequency of cardiac heart disease in patients with carcinoid syndrome, with one study showing 59% of patients diagnosed with tricuspid regurgitation 1
- The importance of cardiology consultation and echocardiogram to assess for carcinoid heart disease in patients with signs and symptoms of heart disease or planned major surgery 1
- The use of somatostatin analogs like octreotide and lanreotide for control of tumor growth and symptom management in patients with clinically significant tumor burden or progressive disease 1
Overall, the management of tachycardia in carcinoid syndrome involves a multifaceted approach that includes treating the underlying tumor, managing symptoms with somatostatin analogs, and monitoring for cardiac complications.
From the Research
Carcinoid Syndrome and Tachycardia
- Carcinoid syndrome is a condition caused by the secretion of bioactive substances by carcinoid tumors, which can lead to various symptoms, including diarrhea, flushing, syncope, and right-sided valvular heart disease 2.
- There is evidence to suggest that carcinoid syndrome can cause tachycardia, as seen in a case report of a patient with metastatic carcinoid tumors who experienced ventricular tachycardia, which was hypothesized to be mediated by the bioactive substances secreted by the tumors 2.
- Another study reported a case of severe hypertension and flushing in a patient with a non-metastatic carcinoid tumor, which was associated with tachycardia during anesthesia 3.
- The bioactive substances secreted by carcinoid tumors, such as serotonin and bradykinin, can produce potentially fatal intraoperative reactions, including hypotension and bronchoconstriction, but can also cause tachycardia 4.
- Treatment options for carcinoid syndrome, such as somatostatin analogues and telotristat, can help alleviate symptoms, including diarrhea and flushing, but their effect on tachycardia is not well established 5, 6.
Mechanism of Tachycardia in Carcinoid Syndrome
- The exact mechanism of tachycardia in carcinoid syndrome is not fully understood, but it is thought to be related to the secretion of bioactive substances by the tumors, which can affect the heart and cardiovascular system 2, 3.
- Further research is needed to understand the relationship between carcinoid syndrome and tachycardia, and to develop effective treatment options for this condition 2, 6.