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Mapelli M, Nepitella AA, Ferdico S, Formenti A, Baggiano A, Campodonico J, Ranieri M, Vettor G, Ianniruberto M, Rizzo S, Basso C, Pontone G, Agostoni P. Hypocalcaemic cardiomyopathy presenting as heart failure exacerbation due to untreated primary hypoparathyroidism. ESC Heart Fail 2024. [PMID: 39257192 DOI: 10.1002/ehf2.15041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2024] [Revised: 08/12/2024] [Accepted: 08/15/2024] [Indexed: 09/12/2024] Open
Affiliation(s)
- Massimo Mapelli
- Centro Cardiologico Monzino IRCCS, Milan, Italy
- Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy
| | - Alessandro Alberto Nepitella
- Centro Cardiologico Monzino IRCCS, Milan, Italy
- Division of Cardiology, Nostra Signora di Bonaria Hospital, San Gavino Monreale, Italy
| | - Stefano Ferdico
- Centro Cardiologico Monzino IRCCS, Milan, Italy
- Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy
| | | | - Andrea Baggiano
- Centro Cardiologico Monzino IRCCS, Milan, Italy
- Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy
| | - Jeness Campodonico
- Centro Cardiologico Monzino IRCCS, Milan, Italy
- Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy
| | - Michela Ranieri
- U.O. Neurologia, Ospedale Vizzolo Predabissi, Vizzolo Predabissi, Italy
| | | | | | - Stefania Rizzo
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua Medical School, Padova, Italy
| | - Cristina Basso
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua Medical School, Padova, Italy
| | - Gianluca Pontone
- Centro Cardiologico Monzino IRCCS, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino IRCCS, Milan, Italy
- Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy
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Kharel M, Subedi A, Hossain MF. Hypocalcemic cardiomyopathy with heart failure: A rare Case report. Clin Case Rep 2024; 12:e9463. [PMID: 39314906 PMCID: PMC11417007 DOI: 10.1002/ccr3.9463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2024] [Revised: 08/18/2024] [Accepted: 09/07/2024] [Indexed: 09/25/2024] Open
Abstract
Hypocalcemia is one of the rarest causes of reversible cardiomyopathy. Patients with refractory heart failure need to be explored for hypocalcemia and need prompt correction. Abstract Hypocalcemia is a rare cause of reversible dilated cardiomyopathy. Correction of calcium is crucial to recover left ventricular function and structure. We presented the case of a 55-year-old female who was admitted to the hospital with refractory heart failure due to hypocalcemia induced by primary hypoparathyroidism and complicated by vitamin D deficiency. The patient's cardiac symptoms improved dramatically upon correction of hypocalcemia, and vitamin D. Therefore, the key clinical message of this case report is, that hypocalcemia, although rare, should be considered as one of the differential diagnoses when heart failure is refractory and early diagnosis and treatment is necessary as it is the cause of reversible cardiomyopathy and could reduce morbidity and mortality.
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Affiliation(s)
| | | | - Md Fahad Hossain
- Ministry of Health and Family WelfareKuliarcharKishoreganjBangladesh
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Abdolmaleki M, Ohadi L, Maleki S. Dilated cardiomyopathy in patients with hypoparathyroidism: A narrative review. Health Sci Rep 2024; 7:e1796. [PMID: 38186939 PMCID: PMC10766877 DOI: 10.1002/hsr2.1796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 11/23/2023] [Accepted: 12/17/2023] [Indexed: 01/09/2024] Open
Abstract
Background Hypoparathyroidism is a rare endocrine disorder characterized by low blood calcium levels, elevated phosphorus levels, and insufficient parathyroid hormone production. It can lead to dilated cardiomyopathy (DCM), a cardiac condition characterized by enlarged ventricles and reduced heart function. This review aims to explore the relationship between hypoparathyroidism and DCM, the impact of calcium on cardiac function, and the potential for DCM reversal with calcium supplementation. Methods A comprehensive literature search was conducted using PubMed, Google Scholar, and relevant keywords and Mesh terms. Case reports evaluating dilated cardiomyopathy in patients with Hypoparathyroidism were included in the study. Additionally, references cited in each study were carefully examined to identify relevant reports. The cases included in the review were analyzed, and common cardiac manifestations, diagnostic approaches, and management were identified. Results DCM in hypoparathyroidism presents with symptoms of heart failure, reduced ejection fraction, and impaired left ventricular function. Laboratory tests show low serum calcium levels and elevated phosphate levels. Prompt diagnosis and treatment with calcium and vitamin D supplementation can lead to improvements in cardiac function. Conclusion Hypoparathyroidism-induced DCM is reversible with timely calcium and vitamin D supplementation. Patient compliance with prescribed medications and supplements is crucial to prevent and manage cardiac complications. Regular follow-up check-ups and monitoring of calcium levels can aid in early detection and improve patient outcomes. Educating patients about the importance of treatment adherence can significantly reduce the risk of developing DCM and other cardiac symptoms associated with hypoparathyroidism. Routine follow-up of DCM among patients with endocrine disorders is recommended.
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Affiliation(s)
| | - Laya Ohadi
- Shahid Beheshti University of Medical Sciences Tehran Iran
| | - Saba Maleki
- School of Medicine Guilan University of Medical Sciences Rasht Iran
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Xie Y, Yang J, Li K, Liu F, Yi Y, Zhang P. Case report: A case of hypocalcemic cardiomyopathy with non-reversible cardiac fibrosis. Front Cardiovasc Med 2023; 10:1166600. [PMID: 37671133 PMCID: PMC10475547 DOI: 10.3389/fcvm.2023.1166600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 07/31/2023] [Indexed: 09/07/2023] Open
Abstract
Hypocalcemic cardiomyopathy is a rare etiology of heart failure. It is considered highly reversible with a relatively favorable prognosis. This case reports a 52-year-old housewife diagnosed with hypocalcemic cardiomyopathy who presented with acute decompensated heart failure and hypocalcemia symptoms with a history of thyroidectomy. Shortness of breath and edema were relieved after diuresis and prompt electrolyte correction. The left ventricular ejection fraction increased from 27% to 53%, and the left ventricular end-diastolic dimension shortened from 58 to 50 mm in echocardiographic re-examinations, while repeat cardiac magnetic resonance imaging revealed evidence of non-reversible cardiac fibrosis after 1-year follow-up. Cardioprotective agents with close follow-ups were called for in this entity of patients.
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Affiliation(s)
- Ying Xie
- Department of Cardiology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Jing Yang
- Department of Cardiology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Kun Li
- Department of Cardiology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Fang Liu
- Department of Cardiology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Yi Yi
- Department of Radiology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Ping Zhang
- Department of Cardiology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
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Varghese EA, Zachariah T. A Case Report on Hypocalcemic Cardiomyopathy: A Rare Cause of Cardiac Failure. Cureus 2023; 15:e43653. [PMID: 37719497 PMCID: PMC10505058 DOI: 10.7759/cureus.43653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2023] [Indexed: 09/19/2023] Open
Abstract
We discuss a case of a 48-year-old man who presented with symptoms of breathlessness, orthopnea, and paroxysmal nocturnal dyspnea. Echocardiogram showed severe left ventricular dysfunction with an ejection fraction of 20% and a coronary angiogram performed later was normal. He was initiated on standard medical management for heart failure. Further blood tests showed that he had severe hypocalcemia secondary to hypoparathyroidism. After the correction of hypoparathyroidism using calcium supplementation and alfacalcidol, his ejection fraction improved to 59%, and 12 weeks later, all anti-failure medications were stopped. A clinical diagnosis of hypocalcemic cardiomyopathy due to hypoparathyroidism was made. The literature review reveals only a few reported cases of heart failure as the initial presentation of dilated cardiomyopathy due to underlying hypocalcemia.
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Affiliation(s)
| | - Tarun Zachariah
- Medicine, Leicester, Northamptonshire and Rutland Deanery, Leicester, GBR
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Garg A, Azad S, Kumar K, Bhatia M, Radhakrishnan S. Role of Cardiac Magnetic Resonance Imaging in Hypocalcemia-Induced Dilated Cardiomyopathy in Pediatric Population. Indian J Radiol Imaging 2022; 31:837-843. [PMID: 35136494 PMCID: PMC8817823 DOI: 10.1055/s-0041-1740541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background
Hypocalcemia is a rare reversible cause of dilated cardiomyopathy in pediatric population. Myocarditis is another more frequent cause of cardiomyopathy with overlapping presenting features. Cardiac magnetic resonance imaging (CMRI) is a vital modality capable of tissue characterization for the evaluation of cardiomyopathy. The present study is the first attempt to determine if any specific characteristics on CMR exist in patients with hypocalcemic dilated cardiomyopathy.
Methods
A retrospective analysis of 10 cases of hypocalcemic dilated cardiomyopathy (August 2012–August 2019), among which CMRI of nine patients were analyzed. Patients were categorized in to three categories; category 1 defined as absence of edema and late gadolinium enhancement (LGE), category 2 having edema only, and category 3 with presence of both edema and LGE. A diagnosis of myocarditis was considered if both edema and LGE were present.
Results
The mean age of the cohort was 5.5 ± 3.3 months. The mean ejection fraction of the cohort was 20.5 ± 6.85% that improved significantly to 35.22 ± 9.3% at the time of discharge. Five of nine patients had no edema or LGE (category 1), whereas two patients each were categorized into category 2 and 3. All cases in category 1 had normalized ventricular function on follow-up. One patient in category 2 had normal ejection fraction and one was lost to follow-up. Out of the two patients in category 3, there was one mortality and another was lost to follow-up. Of the six patients at follow-up (19 ± 11.0 months), the mean left ventricle ejection fraction improved to 56.5 ± 6.1%.
Conclusion
Hypocalcemic dilated cardiomyopathy has a favorable outcome on rapid initiation of treatment. CMR can be utilized for further prognostication of these patients. Absence of edema and LGE predicts a good outcome, whereas presence of LGE and/or edema either indicates a worse prognosis or an underlying coexistent myocarditis warranting an early myocardial biopsy.
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Affiliation(s)
- Ankit Garg
- Department of Pediatric Cardiology, Fortis Escorts Heart Institute, New Delhi, India
| | - Sushil Azad
- Department of Pediatric Cardiology, Fortis Escorts Heart Institute, New Delhi, India
| | - Khemendra Kumar
- Department of Radiodiagnosis, Fortis Escorts Heart Institute, New Delhi, India
| | - Mona Bhatia
- Department of Radiodiagnosis, Fortis Escorts Heart Institute, New Delhi, India
| | - S. Radhakrishnan
- Department of Pediatric Cardiology, Fortis Escorts Heart Institute, New Delhi, India
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Reversible heart failure in a patient with hypocalcemic cardiomyopathy. J Geriatr Cardiol 2021; 18:1063-1067. [PMID: 35136401 PMCID: PMC8782760 DOI: 10.11909/j.issn.1671-5411.2021.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Khatiwada S, Boro H, Farooqui FA, Alam S. Endocrine causes of heart failure: A clinical primer for cardiologists. Indian Heart J 2020; 73:14-21. [PMID: 33714404 PMCID: PMC7961238 DOI: 10.1016/j.ihj.2020.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 07/30/2020] [Accepted: 11/03/2020] [Indexed: 12/30/2022] Open
Abstract
Heart failure (HF) may be a presenting manifestation of a few endocrine disorders and should be considered in evaluation of heart failure causes. This clinically oriented review is an attempt to highlight the protean manifestations of heart failure in endocrine diseases which could present either as acute or chronic heart failure. Acute heart failure manifests as hypertensive crisis, Takotsubo syndrome, or as tachy/brady cardiomyopathies. Chronic heart failure could masquerade with features of hyperdynamic heart failure, or hypertrophic, restrictive or dilated cardiomyopathy. Rarely constrictive features or resistant heart failure could be the presenting feature. Isolated presentation as pulmonary hypertension and right heart failure are also documented. Good history-taking and physical examination with targeted investigations will help in the timely management for reversing the pathophysiology to a significant extent by appropriated management.
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Affiliation(s)
- Saurav Khatiwada
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - Hiya Boro
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India.
| | - Faraz Ahmed Farooqui
- Department of Cardiology, Holy Heart Advanced Cardiac Care and Research Centre, Rohtak, 124001, Haryana, India
| | - Sarah Alam
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
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Válek M, Roblová L, Raška I, Schaffelhoferová D, Paleček T. Hypocalcaemic cardiomyopathy: a description of two cases and a literature review. ESC Heart Fail 2020; 7:1291-1301. [PMID: 32243105 PMCID: PMC7261529 DOI: 10.1002/ehf2.12693] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 03/03/2020] [Accepted: 03/11/2020] [Indexed: 12/11/2022] Open
Abstract
Hypocalcaemic cardiomyopathy is a rare form of dilated cardiomyopathy. The authors here present two cases in which symptomatic dilated cardiomyopathy was the result of severe hypocalcaemia. First, we report about a 26‐year‐old woman with primary hypoparathyroidism and then about a 74‐year‐old man with secondary hypoparathyroidism following a thyroidectomy. In both cases, the left ventricular systolic function improved after calcium supplementation. In the first case, a lack of compliance led to a repeated decrease of both serum calcium level and left ventricular systolic function. The authors also present a comprehensive summary of all cases of hypocalcaemic dilated cardiomyopathy that have been described in literature to date. The mean age of the affected patients was 48.3 years, of which 62% were female patients. The most common causes of hypocalcaemic cardiomyopathy are primary hypoparathyroidism (50%) and post‐thyroidectomy hypoparathyroidism (26%). In the post‐thyroidectomy subgroup, the median time for the development of hypocalcaemic cardiomyopathy is 10 years (range: 1.5 months to 36 years). Hypocalcaemic cardiomyopathy leads to heart failure with reduced ejection fraction in 87% of patients. Generally, the most common complications of hypoparathyroidism and/or hypocalcaemia are cerebral calcifications, cognitive deficit, and cataracts. Once calcium supplementation is administered, the disease has a good prognosis and, in most individuals, a significant improvement (21%) or even normalization (74%) of the left ventricular systolic function occurs.
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Affiliation(s)
- Martin Válek
- Second Department of Medicine, Department of Cardiovascular Medicine, General University Hospital in Prague and First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Lenka Roblová
- Second Department of Medicine, Department of Cardiovascular Medicine, General University Hospital in Prague and First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Ivan Raška
- Third Department of Medicine, Department of Endocrinology and Metabolism, General University Hospital in Prague and First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Dita Schaffelhoferová
- Department of Cardiology, Heart Center, České Budějovice Hospital, České Budějovice, Czech Republic
| | - Tomáš Paleček
- Second Department of Medicine, Department of Cardiovascular Medicine, General University Hospital in Prague and First Faculty of Medicine, Charles University, Prague, Czech Republic
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Ozisik H, Yürekli BS, Tuncel R, Ozdemir N, Baklaci M, Ekmekci O, Saygili F. PSEUDOPSEUDOHYPOPARATHYROIDISM AS A CAUSE OF FAHR SYNDROME: HYPOPARATHYROIDISM NOT THE ONLY ONE. ACTA ENDOCRINOLOGICA-BUCHAREST 2020; 16:86-89. [PMID: 32685044 DOI: 10.4183/aeb.2020.86] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Introduction Fahr's syndrome is an infrequent disorder characterized by bilateral symmetrical calcification of basal ganglia and the cerebral cortex. It can be seen genetic, idiopathic, or secondary to endocrine diseases. This disease is related to different metabolic disorders particularly with diseases of the parathyroid gland. Case 1 A 63-year-old female patient applied to our clinic due to having hypoparathyroidism with bilateral basal ganglia calcification in head computed tomography(CT). She had subtotal thyroidectomy 25 years ago. In the neurological examination, mild symmetrical parkinsonism was determined. In laboratory examination Ca:8 mg/dL (8.6-10.2), P:5.1 mg/dL (2.3-4.5), PTH:9.53 pg/mL (15-65) were detected. Calcitriol 0.25 μ/day was added to her treatment. Her parkinsonism disappeared after the treatment. Case 2 A 49-year-old male patient was consulted when he was admitted to the department of neurology in our hospital. The physical examination demonstrated the characteristics of Albright's hereditary osteodystrophy. The neurological examination shows bilateral symmetrical bradykinesia, dysphagia, and moderate dysarthria. In the laboratory examination PTH: 46.5 ng/L(15-65), Ca:8.6 mg/dL (8.6-10.2), P:2.7 mg/dL (2.3-4.5) were detected and were all within the normal ranges. Consequently, pseudopseudohypoparathyroidism was decided as a diagnosis. G protein alpha subunit mutation (Gsα) was not detected due to technical limitations. Conclusion When a patient is diagnosed as Fahr's syndrome, we should keep in mind parathyroid disorders. Fahr's syndrome must be evaluated in patients showing intracranial calcification accompanied by parathyroid diseases.
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Affiliation(s)
- H Ozisik
- Ege University, Faculty of Medicine, Dept. of Endocrinology, Izmir, Turkey
| | - B S Yürekli
- Ege University, Faculty of Medicine, Dept. of Endocrinology, Izmir, Turkey
| | - R Tuncel
- Ege University, Faculty of Medicine, Dept. of Neurology, Izmir, Turkey
| | - N Ozdemir
- Celal Bayar University, Faculty of Medicine, Dept. of Endocrinology, Manisa, Turkey
| | - M Baklaci
- Ege University, Faculty of Medicine, Dept. of Physical Medicine and Rehabilitation, Izmir, Turkey
| | - O Ekmekci
- Ege University, Faculty of Medicine, Dept. of Neurology, Izmir, Turkey
| | - F Saygili
- Ege University, Faculty of Medicine, Dept. of Endocrinology, Izmir, Turkey
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