🧵⚡️CARCINOID HEART DISEASE 🧵
1/Rare, but interesting cause of intrinsic tricuspid and pulmonary valve disease leading to right heart failure. Once the carcinoid syndrome has developed, 50% of these patients develop CHD.
Follow this #echofirst thread 👇
@NMerke @alexsfelixecho 2/ 90% carcinoid tumours are located in the gastrointestinal system. Only carcinoid tumours that invade the liver result in pathological changes to the heart. Cardiac manifestations are caused by the effects of vasoactive substances such as (5-HT or serotonin) @dr_benoy_n_shah

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70 y F, affected by GPA (granulomatosis with poliangiitis called Wegener's), referred to our centre for SOB, swelling lower limb and plethoric IVC.
Are u thinking Constrictive Pericarditis ⚡️? Let's try to confirm this diagnosis step by step #echofirst @AJamilTajik @JaeKOh2 1⃣ SEPTAL BOUNCE
Paradoxical bouncing motion of IVS in early diastole, at the beginning directed towards LV and then away from LV ➡️ Sign of increased ventricular interdipendence

⚡️THE ANSWER IS IN 3D⚡️
Take a look this thread about MR assessment in a young patient referred for systolic murmur 🧵
A single #3Decho clip can explain your brainstorming in few minutes.
🔜 Never without 3D #echofirst 2/
2D-TTE shows an important prolapse of PML, likely P2 according to PLAX.
Leaflets are thickned, LA dilatated and everything seems easy.

1/⚡️How to assess tricuspid valve by TOE #echofirst?

➡️What's the role of X-plane?
➡️How to get the best 3D image?
➡️Tips and tricks about transgastric view
➡️What we need to know about pacemaker lead

Take a look this thread 🧵
@NMerke @iamritu @hahn_rt @denisamuraru @lpbadano 2/
Usually 3 leaflets, but is not rare to find different morphologies (2 or 4 leafleats)
ANTERIOR➡️largest and longest in radial direction, most mobile
SEPTAL➡️shortest in radial directios and less mobile
POSTERIOR➡️often many scallops, shortest circumferentially