Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2020 Jun 17;2(7):996-1003.
doi: 10.1016/j.jaccas.2020.03.034.

Massive Myocardial Calcium Deposition: Hardened Heart

Mark N Belkin  1 , Mark Dela Cruz  1 , Urooba Nadeem  2 , Amit R Patel  1 , Gene Kim  1 , Jonathan Grinstein  1
Affiliations
Case Reports

Massive Myocardial Calcium Deposition: Hardened Heart

Mark N Belkin et al. JACC Case Rep. .

Abstract

A 25-year-old African-American woman with end-stage renal disease presented with new-onset heart failure. Transthoracic echocardiography indicated a significantly hyperechoic myocardium, and computed tomography noted a circumferential hyperattenuated myocardium. Endomyocardial biopsy revealed focal interstitial and intramyocyte calcium deposition in the heart, confirming a rare diagnosis of massive myocardial calcium deposition. (Level of Difficulty: Beginner.).

Keywords: CT, computed tomographic; EMB, endomyocardial biopsy; ESRD, end-stage renal disease; HF, heart failure; cardiomyopathy; disorders of calcium metabolism; restrictive.

PubMed Disclaimer

Figures

None
Graphical abstract
Figure 1
Figure 1
Electrocardiogram
Figure 2
Figure 2
Echocardiogram (A) Pulsed-wave Doppler through the mitral valve. (B) Tissue Doppler of the medial mitral valve annulus. (C) Tissue Doppler of the lateral mitral valve annulus. DT = E-wave deceleration time; E = E wave; e′ = e′ mitral velocity.
Figure 3
Figure 3
Computed Tomography Imaging of the Chest (A) Computed tomographic (CT) imaging of the chest. Arrows denote calcified myocardium. (B) Contrast-enhanced CT imaging of the chest with multiplanar reformatting in the 4-chamber view. (C) Contrast-enhanced CT imaging of the chest with multiplanar reformatting in the short-axis view. A = calcified myocardium; B = noncalcified endocardium; LA = left atrium; LV = left ventricle; RA = right atrium; RV = right ventricle.
Figure 4
Figure 4
Right Heart Catheterization Tracings PA = pulmonary artery pressure; PCWP = pulmonary capillary wedge pressure; RA = right atrial pressure; RV = right ventricular pressure.
Figure 5
Figure 5
Endomyocardial Biopsy With Routine Stain Arrows denote intracellular calcium deposits.
Figure 6
Figure 6
Endomyocardial Biopsy With Von Kossa Stain Arrows denote intracellular calcium deposits.
Figure 7
Figure 7
Pathophysiology of Secondary Hyperparathyroidism CKD = chronic kidney disease; GI = gastrointestinal; PTH = parathyroid hormone.
See this image and copyright information in PMC

References

    1. Joyce E., Fabre A., Mahon N. Hydroxychloroquine cardiotoxicity presenting as a rapidly evolving biventricular cardiomyopathy: key diagnostic features and literature review. Eur Heart J Acute Cardiovasc Care. 2013;2:77–83. - PMC - PubMed
    1. Yu Z., Gu L., Pang H., Fang Y., Yan H., Fang W. Sodium thiosulfate: an emerging treatment for calciphylaxis in dialysis patients. Case Rep Nephrol Dial. 2015;5:77–82. - PMC - PubMed
    1. Na J.Y. A heart of stone: an autopsy case of massive myocardial calcification. Forensic Sci Med Pathol. 2018;14:102–105. - PubMed
    1. Matsui M., Okayama S., Takitsume A. Heart failure associated with metastatic myocardial calcification in a hemodialysis patient with progressive calcification of the hand. Cardiorenal Med. 2012;2:251–255. - PMC - PubMed
    1. Isotalo P.A., Halil A., Green M., Tang A., Lach B., Veinot J.P. Metastatic calcification of the cardiac conduction system with heart block: an under-reported entity in chronic renal failure patients. J Forensic Sci. 2000;45:1335–1338. - PubMed

Publication types