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CardioNerds\xa0(Amit Goyal\xa0&\xa0Daniel Ambinder) join Boston University cardiology fellows (Yuliya Mints, Anshul Srivastava, and Michel Ibrahim) for some hotdogs at Fenway Park in Boston, MA. They discuss an educational case of carcinoid heart disease with severe tricuspid regurgitation. Program director, Dr. Omar Siddiqi provides the E-CPR and APD Dr. Katy Bockstall provides a message for applicants. Episode notes were developed by Johns Hopkins internal medicine resident\xa0Bibin Varghese\xa0with mentorship from University of Maryland cardiology fellow\xa0Karan Desai.\xa0\xa0\xa0\n\n\n\n\n\nJump to: Patient summary - Case media - Case teaching - References \n\n\n\nEpisode graphic by Dr. Carine Hamo\n\n\n\n\n\n\n\nThe\xa0CardioNerds Cardiology Case Reports\xa0series shines light on the hidden curriculum of medical storytelling. We learn together while discussing fascinating cases in this fun, engaging, and educational format. Each episode ends with an\xa0\u201cExpert CardioNerd Perspectives & Review\u201d (E-CPR)\xa0for a nuanced teaching from a content expert. We truly believe that hearing about a patient is the singular theme that unifies everyone at every level, from the student to the professor emeritus.\n\n\n\nWe are teaming up with the\xa0ACC FIT Section\xa0to use the\xa0#CNCR episodes\xa0to showcase CV education across the country in the era of virtual recruitment. As part of the recruitment series, each episode features fellows from a given program discussing and teaching about an interesting case as well as sharing what makes their hearts flutter about their fellowship training. The case discussion is followed by both an\xa0E-CPR\xa0segment and a message from the program director.\n\n\n\nCardioNerds Case Reports PageCardioNerds Episode PageCardioNerds AcademySubscribe to our newsletter- The HeartbeatSupport our educational mission by becoming a Patron!Cardiology Programs Twitter Group created by Dr. Nosheen Reza\n\n\n\n\n\n\n\n\n\n\n\nPatient Summary\n\n\n\nA woman in her mid 60s\xa0with history of neuroendocrine tumor (NET) presented to the cardio-oncology clinic with chronic progressive SOB and fatigue. She was diagnosed with NET after presenting with a\xa0small bowel obstruction (SBO) several years prior. At the time, she was found to have liver and pulmonary metastasis with MR\xa0enterography\xa0showing thickening of the terminal ileum.\xa0Ileocecetomy\xa0and biopsy of the liver lesions confirmed metastatic NET. Despite treatment with octreotide and\xa0everolimus, follow up CT showed progression of liver lesions and she was eventually started on\xa0telotristat\xa0and enrolled in a clinical trial.\xa0On presentation, she was not tachycardiac, hypotensive or requiring oxygen supplementation (KD: Correct?).\xa0On exam, she demonstrated elevated JVP with a\xa0positive hepato-jugular reflex\xa0and a 3/6\xa0holosytolic\xa0murmur loudest at the LLSB that increased with inspiration.\xa0Lab work revealed\xa0urinary 5-HIAA was 212 (nl\xa0< 6mg/24 hours). TTE showed moderately dilated RV and severely dilated RA.\xa0Furthermore, there was a\xa0thickened, calcified and retracted TV with severe TR which was consistent with carcinoid heart disease. She was treated with diuretics and was continued on systemic therapies to help achieve control of her NET before surgical intervention for her valvular disease was considered.\xa0\xa0\n\n\n\n\n\n\n\nCase Media\n\n\n\n\nABClick to Enlarge\n\n\n\nA. ECGB. TTE: CW Doppler through tricuspid valve \n\n\n\n\n\nCarcinoid - TTE 1 \n\n\n\n\n\n\n\n\n\nCarcinoid - TTE 2\n\n\n\n\n\nCarcinoid - TTE 3\n\n\n\n\n\n\n\nCarcinoid - TTE 4\n\n\n\n\n\nCarcinoid - TTE 5\n\n\n\n\n\nCarcinoid - TTE 6\n\n\n\n\n\n\n\nCarcinoid - TTE 7\n\n\n\n\n\nCarcinoid - TTE 8\n\n\n\n\n\nCarcinoid - TTE 9\n\n\n\n\n\n\n\n\n\n\n\n\n\n\nEpisode Schematics & Teaching\n\n\n\n\n\n\n\n\n\n\n\nThe CardioNerds 5! \u2013 5 major takeaways from the #CNCR case\n\n\n\nThe patient had an NET history and presented with shortness of breath.\xa0Under what circumstances do patients with NETs present with\xa0cardiac\xa0symptoms?\xa0Amongst patients with neuroendocrine tumors (NETs), carcinoid tumors refer classically to gastrointestinal NETs.\xa0Around 30 to 40% of these patients will presents with features of carcinoid syndrome,