Hypocalcemic cardiomyopathy presenting as cardiogenic shock

Abstract

Hypocalcemia is a less known but treatable cause for dilated cardiomyopathy, leading to severe heart failure in children. Cardiogenic shock related to hypocalcemic cardiomyopathy is a rare event. We describe 5 infants presenting with cardiogenic shock over 3 years, who were found to have severe hypocalcemia as a sole cause of myocardial dysfunction. The patients responded to calcium and vitamin D supplementation promptly and left ventricular systolic function normalized within months of treatment. In any case of cardiogenic shock, hypocalcemia should be included in the differential diagnosis and must be investigated.

Vitamin D and the heart

“…Heart failure has been reported in infants with rickets (3,11,28,31,39), although, in this setting, profound hypocalcemia may contribute to the observed cardiac dysfunction. In one…”

“…CVD is the leading cause of death in patients with chronic kidney disease (27,28), and some element of cardiac hypertrophy is present in most patients with advanced kidney disease. Park et al (52) were the first to demonstrate that administration of 1,25(OH) 2 D 3 to hemodialysis patients with secondary hyperparathyroidism resulted in a dramatic reduction of left ventricular hypertrophy, as well as reduction in plasma renin, ANG II, and ANP levels.…”

Complications of vitamin D deficiency from the foetus to the infant: One cause, one prevention, but who's responsibility?

“…In the two largest case series, most [40] or all [41] infants with dilated CMP also had rickets, whereas in others there were apparently no clinical signs of rickets, or no x-rays taken [42,43]. Some of these infants had presented with hypocalcaemic seizures [43] or cardiogenic shock [44,45]. In all reports, infants were from darkskinned ethnic background, were breastfed, and their 25OHD levels were in the deficiency range, with typical biochemical markers associated with rickets [40e47].…”

Hypocalcemic cardiomyopathy as initial presentation of primary hypoparathyroidism

“…Myocardial dysfunction due to hypocalcemia has been documented in many experimental animal studies and also in various clinical reports . The role of calcium in cardiac contraction is well known.…”