Cardiac failure secondary to hypocalcaemia of nutritional osteomalacia

Avery, Pearl; Arnold, I R; Hübner, Peter; Iqbal, S. J.

doi:10.1093/oxfordjournals.eurheartj.a060187

Cited by 15 publications

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“…In several case reports, 1‐4,6–9 chronic undiagnosed hypocalcemia due to hypoparathyroidism resulted in severe heart failure or dilated cardiomyopathy. As mentioned above, clinical and hemodynamic improvement could not be achieved with the usual antifailure therapy unless serum calcium deficiency was corrected.…”

Section: Discussionmentioning

confidence: 99%

“…As mentioned above, clinical and hemodynamic improvement could not be achieved with the usual antifailure therapy unless serum calcium deficiency was corrected. Similarly, heart failure was initially controlled with a low dose of diuretic in a woman with osteomalacia, but it was then refractory to this therapy because of hypocalcemia accompanied by hyperphosphatemia 6 …”

Section: Discussionmentioning

confidence: 99%

“…Dilated cardiomyopathy is characterized by the cardiac enlargement and impaired systolic function of one or both ventricles. Hypocalcemia is a rare and reversible cause of heart failure or dilated cardiomyopathy 1–9 …”

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confidence: 99%

“…Several case reports with regard to hypocalcemic dilated cardiomyopathy or heart failure have been reported in adults 1–9 . However, two of them included hypocalcemia‐induced heart failure after strumectomy 3,7 .…”

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A Rare Cause of Reversible Dilated Cardiomyopathy: Hypocalcemia

2004

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Hypocalcemia is a rare cause of reversible heart failure. We reported a 40-year-old woman who had severe heart failure resistant to the usual antifailure therapy. She had severe hypocalcemia due to hypoparathyroidism after strumectomy. Echocardiography showed a large left ventricle with very low ejection fraction of 25% and moderate mitral regurgitation. After supplementation of calcium and vitamin D, her clinical situation and hemodynamics improved rapidly. At 15 months, myocardial impairment resolved fully. In conclusion, hypocalcemia should be considered in the differential diagnosis of resistant severe heart failure.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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A Rare Cause of Reversible Dilated Cardiomyopathy: Hypocalcemia

2004

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“…• Blood salvage may be life-saving if substantial blood-loss anticipated 1,31 . Check if acceptable to patient.…”

Section: Risk Factors Predisposing To Postpartum Haemorrhagementioning

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2008

Medical Disorders in Pregnancy

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Irreversible End‐stage Heart Failure in a Young Patient due to Severe Chronic Hypocalcemia Associated with Primary Hypoparathyroidism and Celiac Disease

Mavroudis¹,

Aloumanis²,

Stamatis

et al. 2010

Clinical Cardiology

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Background: Chronic hypocalcemia may cause electrocardiographic (ECG) changes and mimic acute myocardial infarction. It has also been associated with reversible cardiac dysfunction. On the other hand cardiomyopathy and heart failure have been reported in patients with idiopathic hypoparathyroidism or celiac disease. Clinical Case: A 39-year-old male was admitted to the emergency room with acute retrosternal pain and dyspnea. He exhibited severe hypocalcemia and acute renal failure. High creatine kinase (CK) levels did not correlate with biomarkers of myocardial necrosis (negative troponin test, heart type creatine kinase isoenzyme (CK-MB) <1% of CK value). The ECG showed an extremely long QT interval (0.6 sec) and T-wave inversions on V 4 through V 6 . The left ventricular ejection fraction (LVEF) was as low as 25%, while coronary angiography was normal. Investigation of the hypocalcemia revealed primary hypoparathyroidism (Parathyroid hormone (PTH) <3 pg/ml) and concomitant celiac disease with positive antigliadin and endomysial antibodies. The cardiovascular episodes and the dilated heart failure were attributed to the chronic hypocalcemia since no other cause was found. The correction of hypocalcemia has not been sufficient to reverse the end-stage heart failure after more than 6 months of treatment, even though ECG abnormalities have receded, implying permanent cardiac impairment. Conclusion: This case demonstrates an unusual clinical condition where 2 calcium homeostasis disorders led to severe hypocalcemia with clinical manifestations of end-stage heart failure. The severe cardiac failure appeared to be nonreversible after calcium repletion suggesting permanent cardiac muscle dysfunction due to associated cardiomyopathy. IntroductionSevere chronic hypocalcemia may predominantly be presented with paresthesias, neuromuscular irritability, and tetany, but can sometimes manifest cardiovascular complications like hypotension, myocardial dysfunction, prolongation of the QT interval, and triggered dysrhythmias like torsades de pointes, decreased myocardial performance, and even heart failure.1 Hypocalcemia induced heart failure (or hypocalcemic heart failure) has been associated with various clinical entities like idiopathic or postsurgical hypoparathyroidism, vitamin D deficiency, and celiac disease. 2,3,4 The symptoms are often misleading and, consequently, endocrine causes of heart failure are sometimes overlooked.The case of a 39-year-old man, who upon evaluation for clinical acute myocardial syndrome and end-stage heart failure was diagnosed with primary hypoparathyroidismand celiac disease, is presented and the role of these diseases in heart function is discussed.

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Cardiac failure secondary to hypocalcaemia of nutritional osteomalacia

Cited by 15 publications

References 0 publications

A Rare Cause of Reversible Dilated Cardiomyopathy: Hypocalcemia

A Rare Cause of Reversible Dilated Cardiomyopathy: Hypocalcemia

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Irreversible End‐stage Heart Failure in a Young Patient due to Severe Chronic Hypocalcemia Associated with Primary Hypoparathyroidism and Celiac Disease

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