Hypocalcaemic cardiomyopathy: a description of two cases and a literature review

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.

Keywords: Calcium; Dilated cardiomyopathy; Heart failure; Hypocalcaemia; Hypoparathyroidism; Parathormone.

Figure 1

The picture shows markedly carious dentition and dry peeling skin.

Figure 2

The figure shows M mode tracings of the left ventricle that demonstrate significant improvement of left ventricular systolic function in November 2018 when the patient received oral treatment of hypoparathyroidism under supervision.

Figure 3

The figure depicts a noticeable increase of early diastolic septal mitral annular velocity (e′) in November 2018, reflecting the improvement in myocardial relaxation properties when the patient received oral treatment of hypoparathyroidism under supervision.

Figure 4

The aetiology of the majority of cases of hypocalcaemic cardiomyopathy is hypoparathyroidism, as shown on the left side of the figure. The right side depicts causes of hypoparathyroidism and shows that primary hypoparathyroidism represents most cases.