Hypocalcemic Cardiomyopathy

Bashour, Tali T.; Basha, Hassan Shamsi; Cheng, Tsung O.

doi:10.1378/chest.78.4.663

Cited by 73 publications

(42 citation statements)

References 8 publications

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“…A low PTH level leads to a low free cytosolic calcium concentration in the distal tubular cells, which, in turn, will increase renal sodium reabsorption through a Na C -Ca 2C exchange mechanism (57,58); this phenomenon was observed in parathyroidectomized rats in which PTH infusion normalized the associated 40% reduction in renal Na C -Ca 2C exchange (59). Water and sodium retention may thus exacerbate heart failure in the setting of hypocalcemia (6). In our patient, rhPTH was given mainly to induce phosphaturia because of the very high serum inorganic phosphate level.…”

Section: Discussionmentioning

confidence: 85%

“…Hypocalcemic cardiomyopathy has been described in more than 25 reports in the literature and in all age groups (3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33). We conducted a search in Pubmed using keywords 'hypocalcemia (all fields) AND heart failure (all fields)' yielding 221 entries.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, the duration and amplitude of the calcium influx have been shown to affect the strength of cardiomyocyte contraction (6,21). Experimental studies demonstrated reduced cardiac contractility in hypocalcemic states, as evidenced by decreased LV performance and cardiac index (44,45), and suggested an increase in myocardial contractility and cardiac output with calcium correction (46,47).…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Use of recombinant human parathyroid hormone in hypocalcemic cardiomyopathy

Ballane

Sfeir

Dakik³

et al. 2012

European Journal of Endocrinology

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Hypocalcemia secondary to hypoparathyroidism is a rare cause of congestive heart failure. However, its early recognition and treatment lead to significant improvement in cardiac function. We report a middle-aged woman presenting with symptoms of heart failure with a serum calcium level of 3.7 mg/dl and a serum inorganic phosphate level of 17.6 mg/dl 22 years after subtotal thyroidectomy. Besides calcium and calcitriol supplementation, she was the first patient with severe hypocalcemic cardiomyopathy to be given off-label recombinant human parathyroid hormone (PTH) because of an elevated serum calcium–phosphate product. We discuss the management and outcome of the patient and then present a brief review of similar previously reported cases. We also describe the pivotal role of calcium ion and the potential role of PTH in maintaining myocardial contractility, effective natriuresis, and possible pathogenic mechanisms contributing to heart failure secondary to hypocalcemia and hypoparathyroidism.

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Section: Discussionmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Use of recombinant human parathyroid hormone in hypocalcemic cardiomyopathy

Ballane

Sfeir

Dakik³

et al. 2012

European Journal of Endocrinology

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“…All of these cases were associated with hypocalcemia, which was severe in two cases and mild in the third case. A causal link between denosumab and these instances of pulmonary edema is still not established; yet, calcium ions are known to play a vital role in cardiac contractility and conduction, and severe hypocalcemia is previously described as a reversible cause of cardiac failure [21]. In this context, it appears advisable to aggressively correct denosumab-induced hypocalcemia in the presence of cardiac dysfunction.…”

Section: Discussionmentioning

confidence: 99%

Hypocalcemia Post Denosumab in Patients with Chronic Kidney Disease Stage 4-5

Chiang²,

et al. 2015

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Background: Denosumab, a RANK-ligand inhibitor, is an effective treatment for osteoporosis in postmenopausal women and men. Unlike the bisphosphonates, it is not excreted by the kidney. Little is known, however, about its efficacy and safety in patients with severe chronic kidney disease (CKD). Methods: A retrospective study was performed in CKD 4-5D patients from a tertiary referral hospital who were treated with denosumab between 1st January 2011 and 31st March 2014. Data collected included information about the following: CKD stage, fracture history, bone mineral density, serum calcium levels pre and post denosumab treatment, episodes of hypocalcemia, relevant medications and adverse events. Results: Eight patients with CKD-5 and 6 patients with CKD-4 were identified (all female, mean age 77.1 ± 9.9). The mean pre-denosumab calcium value was 2.42 ± 0.12 mmol/l, PTH 20.2 ± 14.7 pmol/l and 25-OH vitamin D 69.1 ± 30.1 nmol/l. After denosumab treatment, 6/8 patients with CKD-5/5D, and 2/5 patients with CKD-4 developed severe hypocalcemia. Two patients developed direct adverse complications of hypocalcemia (seizure, laryngospasm, prolonged QT_c). Among the patients who developed hypocalcemia, the median time to serum calcium nadir was 21 days and the median time to correction of hypocalcemia was 71 days. Treatment of hypocalcemia required large doses of oral calcium and calcitriol, and increases in dialysate calcium concentration. Conclusions: A high rate of severe hypocalcemia was observed in patients with advanced CKD treated with denosumab. If denosumab is used in patients with severe CKD, close monitoring and aggressive replacement of calcium and calcitriol is required to avoid the development of hypocalcemia.

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“…The relatively normal ejection fraction of 50% first docu mented after dialysis could be explained by the fact that heart failure had already improved. Furthermore, the [4][5][6][7]. Apart from the chronic anemia, our patient also had mild mitral regur gitation with a mildly thickened mitral valve.…”

Section: Discussionmentioning

confidence: 89%

Hypocalcemic Heart Failure in End-Stage Renal Disease

Wong

Pun²,

Cheng³

et al. 1990

Am J Nephrol

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A 37-year-old woman presented with hypocalcemic heart failure complicating end-stage renal disease. Heart failure persisted despite conventional therapy but improved after correction of hypocalcemia. Continuous monitoring of left ventricular function by radionuclide study during calcium replacement showed dramatic improvement. Our case showed that hypocalcemia could be a rare but reversible cause of frank heart failure in uremic patients.

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Hypocalcemic Cardiomyopathy

Cited by 73 publications

References 8 publications

Use of recombinant human parathyroid hormone in hypocalcemic cardiomyopathy

Use of recombinant human parathyroid hormone in hypocalcemic cardiomyopathy

Hypocalcemia Post Denosumab in Patients with Chronic Kidney Disease Stage 4-5

Hypocalcemic Heart Failure in End-Stage Renal Disease

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