Heart Failure Associated with Metastatic Myocardial Calcification in a Hemodialysis Patient with Progressive Calcification of the Hand

Abstract

Metastatic myocardial calcification is a frequent cause of heart failure in hemodialysis patients. However, early detection is difficult, often resulting in a poor prognosis. A 47-year-old man with hemodialysis-dependent end-stage renal disease presented with progressive dyspnea. Levels of serum phosphate, calcium, and intact parathyroid hormone were poorly controlled. He developed pain in his right thumb 1 year before presentation, and the pain gradually increased and extended to the entire right hand. Hand radiography 1 month earlier had revealed significant progressive calcification. Echocardiography showed severe, diffuse hypokinesis and pericardial effusion as well as possible anterior myocardial calcification with high echogenicity. Chest computed tomography revealed a severely dilated heart with anterior massive myocardial calcification and a large amount of pericardial effusion, which was not detected on computed tomography performed 20 months earlier. The patient was diagnosed with heart failure associated with metastatic myocardial calcification and died suddenly 2 weeks later. This experience suggests that progressive metastatic calcification of the skin and subcutaneous tissue is useful for predicting myocardial calcification.

Fig. 1

Hand radiogram 1 year (a) and 1 month (b) before presentation. Interval development of severe subcutaneous calcium deposits was observed.

Fig. 2

Electrocardiogram on admission. Premature atrial contraction with atrioventricular block, poor R wave progression in V1–3, and flattening or depression of T waves in I, aVL, V5, and V6 were observed.

Fig. 3

Echocardiogram on admission. Severe diffuse hypokinesis with an ejection fraction of 30% and pericardial effusion (asterisk) were observed, and anterior myocardial calcification with high echogenicity was suspected (arrowheads).

Fig. 4

Chest CT scan 20 months before presentation (a) and on admission (b). Interval development of a severely dilated heart with anterior massive myocardial calcification (arrowheads) and a large amount of pericardial effusion (asterisks) were observed.