Hypocalcemic heart failure masquerading as dilated cardiomyopathy

Abstract

Hypocalcemia is a rare, but reversible, cause of congestive heart failure. We report a 4-month-old boy diagnosed as dilated cardiomyopathy who had prolonged QoTc with low blood levels of calcium, normal phosphate, elevated alkaline phosphatase and findings suggestive of rickets. In view of non response to calcium and vitamin D3, a possible diagnosis of VDDR I (Vitamin D-dependent rickets) was made and he was treated with calcium and calcitriol. The serum calcium levels normalised within 10 days, along with resolution of the signs and symptoms of heart failure, near normal left ventricular function and normalisation of QoTc. Pediatricians should be aware of the association of hypocalcemia with cardiac dysfunction and should keep it as a possible reversible cause of heart failure in children.

Use of recombinant human parathyroid hormone in hypocalcemic cardiomyopathy

“…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.…”

Hypocalcemic cardiac failure in the Emergency Department

“…Rallidis et al (in 1997) and Fisher et al (in 2001) described cases of hypocalcemic heart failure where enzymatic markers such as CK were elevated, suggesting that this type of heart failure may mimic myocardial infarction (4,22). The EKG changes associated with hypocalcemic heart failure may persist for days to months despite normalization of cardiac function and resolution of symptoms (26). At the time of discharge, the prolonged QT interval in this patient persisted (Day 8) and later follow-up EKGs were not available for review.…”

Une cause réversible de la cardiomyopathie dilatée : l’hypocalcémie

“…L'hypocalcémie compliquée d'insuffisance cardiaque a été associée aux différentes entités pathologiques comme la maladie coeliaque, l' hypoparathyroïdie, en post chirurgie, et en cas de carence en vitamine D [5][6][7]. Les symptômes sont souvent trompeurs ou même insidieux si l hypocalcémie est d'installation chronique et progressive, et par conséquent les causes endocriniennes de l'insuffisance cardiaque sont parfois négligées [4].…”