Exacerbation of Latent Heart Failure by Mild Hypocalcemia after Parathyroidectomy in a Long-Term Hemodialysis Patient

Abstract

A 60-year-old uremic patient treated with hemodialysis for 13 years developed acute hypotension during hemodialysis and overt heart failure subsequently in a period of relatively mild hypocalcemia after parathyroidectomy. Blood pressure during hemodialysis was maintained by continuous calcium infusion alone. Cardiomegaly was improved by normalization of serum calcium. The cardiac complication is considered to be exacerbation of the underlying myocardial dysfunction by the acute decline of serum calcium which might be a feature of the ‘hungry bone’ syndrome. Latent myocardial dysfunction might be exacerbated by only mild hypocalcemia after parathyroidectomy in long-term hemodialysis patients.

Pseudohypoparathyroidism and Cardiomyopathy: A Case Report with a New Perspective on the Cardiovascular-Endocrine Axis with Respect to Calcium Homeostasis

“…This study found that 3 months after normalization of calcium by oral therapy, both maximum cardiac output and maximum heart rate demonstrated a statistically significant increase during peak exercise, thus concluding that hypocalcaemia impairs cardiac performance, but that this impairment is reversible with calcium replacement [5] . Several case reports have demonstrated similar findings; that is, hypocalcaemia is a reversible and, more importantly, easily treatable cause of heart failure [6–10] .…”

Fatal Hypocalcemia Due to Hungry Bone Syndrome after Total Parathyroidectomy

“…Consequently, the clinical features of hungry bone syndrome are due to hypocalcemia, hypophosphatemia, hypomagnesemia, and hyperkalemia.The serum calcium typically reaches a nadir two to four days postoperatively [2]. Hypocalcemia resulting in overt heart failure has been described in patients with latent myocardial dysfunction where cardiomegaly and pulmonary congestion resolved after normalization of the serum calcium [9,10]. Careful monitoring two to four times per day for the first few postoperative days is required to prevent and treat symptomatic hypocalcemia, which can be potentially catastrophic.…”

“…The underlying hyperparathyroidism can either be primary or secondary due to endstage renal disease. Acute hypocalcemia has been known to cause myocardial dysfunction, poor myocardial performance and even congestive heart failure either with or without hypotension [3][4][5][6][7][8]. We herein present a woman with profound hypocalcemia due to hbswho progressed to cardiopulmonary arrest.…”

Calcitriol loading before total parathyroidectomy with autotransplant in patients with end‐stage kidney disease: does it prevent postoperative hypocalcaemia?

“…This occurs as a consequence of low circulating parathyroid hormone resulting in decreased osteoclast mediated bone resorption . When hypocalcaemia is severe, life‐threatening complications can occur including seizure, arrhythmia and decompensated heart failure …”

“…4,5 When hypocalcaemia is severe, life-threatening complications can occur including seizure, arrhythmia and decompensated heart failure. 6,7 Recent studies into HBS suggest an incidence of 27%-31% in the ESKD population. [8][9][10] Despite the high incidence, there are conflicting data regarding its clinical course, risk factors and the best strategy for its prevention.…”