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failure is a common health problem among older adults, arising out of multiple etiologic factors that are often irreversible, 1 and reversible causes of myocardial dysfunction are often overlooked. A case of reversible heart failure due to hypocalcaemia resulting from vitamin D deficiency is reported. CASE REPORTAn 87-year-old man was referred from another hospital with progressive and disabling shortness of breath of 1 week duration after he developed an episode of ventricular tachycardia (VT) with spontaneous remission. He had mild fever and productive cough. Before this illness, he was in his usual state of health, with well-controlled hypertension and chronic obstructive pulmonary disease (COPD), and was competent in all basic activities of daily living. He had never smoked but had had pulmonary tuberculosis in his early 30s; simple renal cysts had been detected during earlier investigation for hypertension.Examination revealed a dyspneic man with blood pressure of 134/70 mmHg, regular pulse of 120 beats per minute, respiratory rate of 32 breaths per minute, and oxygen saturation of 86% on room air and 95% with 2 L of oxygen through nasal prongs. Respiratory examination found inspiratory and expiratory wheeze with bilateral basal crackles. Cardiovascular examination revealed tachycardia and cardiomegaly. The rest of the examination was normal.Laboratory evaluation revealed calcium 5.6 mg/dL (normal 8.1-10.4 mg/dL), phosphate 3.5 mg/dL (normal 2.5-4.5 mg/dL), alkaline phosphatase 156 IU (normal 80-240 IU), vitamin D3 11 ng/mL (normal 30-100 ng/mL), parathyroid hormone (PTH) 15.58 pg/mL (normal 15-65 pg/mL), and magnesium 1.6 mg/dL (normal 1.8-2.4 mg/dL). Electrocardiogram showed tachycardia, and echocardiogram revealed dilated cardiomyopathy, mild concentric left ventricular hypertrophy (LVH), and ejection fraction (EF) of 35% to 40%. Twenty-four-hour Holter monitoring revealed frequent supraventricular ectopic heart beats and one run of nonsustained VT. Investigations for reactivated tuberculosis were negative. Contrastenhanced computed tomography of the chest and abdomen showed consolidation in the left upper lobe on a background of fibrocalcific changes in both upper lobes of the lung and bilateral simple renal cortical cysts.He refused any invasive investigation, so coronary angiogram was not performed.A diagnosis of severe vitamin D deficiency with hypocalcemia-induced dilated cardiomyopathy, congestive heart failure, COPD, and pneumonia was made. He was treated using calcium gluconate and magnesium infusion, and hypocalcemia and hypomagnesemia were corrected. Oral calcium and magnesium and vitamin D3 supplementation were started. Heart failure was treated using intravenous diuretics, and COPD was controlled using nebulized bronchodilators. His pneumonia was treated using intravenous amoxicillin with clavulanate and azithromycin initially, followed by oral amoxicillin with clavulanate for 1 week. He was discharged to home in 2 weeks. Detailed followup assessment after 6 months revealed amelioration of mos...

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Background The integral part of the definition of frailty is the outcome associated with it. Older adults at risk of frailty are in the process of becoming frail. This study looked at the clinical characteristics and outcomes of older adults at risk of frailty. Methodology The study population was selected from outpatient department of the geriatric medicine department in a tertiary care hospital. Older adults identified as at risk of frailty were assessed at baseline and then followed up after 1 year for the composite primary outcome of death, falls, hospitalization, and self‐rated poor quality of life in the follow‐up period. Results The study included 324 older adults who had completed 1‐year follow up. Mean (SD) age was 74.49 (4.58) years, and males were 241 (74.15%). Frail and pre‐frail at baseline among the study population were 31.17% and 61.11%, respectively. The primary outcome occurred in 43 (13.27%) patients. Poor baseline IADL was significantly associated with primary outcome at the end of 1 year. Conclusion An unfavorable outcome in older adults at risk of frailty was significantly higher and independent of their baseline frailty status. Poor baseline IADL value may be considered as a predictor for primary outcome at 1 year of follow up.