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Open access

Kun Zhang, Lukas J Lehner, Damaris Praeger, Gert Baumann, Fabian Knebel, Marcus Quinkler and Torsten K Roepke

Summary

Neuroendocrine tumours (NETs) represent a broad spectrum of tumours, of which the serotonin-producing carcinoid is the most common and has been shown to cause right ventricular heart failure. However, an association between heart failure and NETs other than carcinoid has not been established so far. In this case report, we describe a 51-year-old patient with a glucagon-producing NET of the pancreas who developed acute heart failure and even cardiogenic shock despite therapy. Heart failure eventually regressed after initialising i.v. treatment with the somatostatin analogue octreotide. Chromogranin A as a tumour marker was shown to be significantly elevated, and it decreased with clinical improvement of the patient. The effects of long-time stimulation of glucagon on the myocardium have not been studied yet; however, sarcoplasmic reticulum calcium leak can be discussed as a possible mechanism for glucagon-induced heart failure.

Learning points

  • Glucagonoma can be a cause for heart failure.

  • i.v. infusion of octreotide can be successfully used to treat glucagonoma-induced acute heart failure.

  • We suggest that cardiac function should be monitored in all NET patients.

Open access

M S Draman, H Thabit, T J Kiernan, J O'Neill, S Sreenan and J H McDermott

Summary

Silent myocardial ischaemia (SMI), defined as objective evidence of myocardial ischaemia in the absence of symptoms, has important clinical implications for the patient with coronary artery disease. We present a dramatic case of SMI in a diabetes patient who attended annual review clinic with ST elevation myocardial infarction. His troponin was normal on admission but raised to 10.7 ng/ml (normal <0.5) when repeated the next day. His angiogram showed diffused coronary artery disease. We here discuss the implications of silent ischaemia for the patient and for the physician caring for patients with diabetes.

Learning points

  • Silent myocardial ischaemia (SMI) is an important clinical entity.

  • SMI is common and occurs with increased frequency in patients with diabetes.

  • SMI is an independent predictor of mortality.

  • Recognition may lead to early intervention.