Hypocalcemic cardiomyopathy: A case report

Abstract

Hypocalcemia and its related symptoms are common manifestations in postsurgical hypoparathyroidism, but patients with hypocalcemia manifested as heart failure is rare and few cases are reported in the literature. Here we reported a 58-year-old female with hypoparathyroidism and uncontrolled hypocalcemia after thyroidectomy, presented with acute heart failure, accompanied with enlargement and reduced ejection fraction of left ventricle. She was refractory to guideline-directed medical therapy for heart failure including digitalis and diuretics. However, her symptoms resolved and cardiac function improved dramatically after normalization of serum calcium level. This rare case highlights the pivotal role of calcium in maintaining cardiac function and the importance of treating underlying reversible causes of heart failure. For patients with hypoparathyroidism, it is essential to get standard treatment to avoid development of heart failure and hypocalcemia related syndromes.

Keywords: heart failure; hypocalcemia; hypocalcemic cardiomyopathy; hypoparathyroidism; thyroidectomy.

Figure 1

(A) The ECG at admission (speed 25 mm/s, 10 mm/mV) with HR 128 beats/min and QTc interval of 502 ms. (B) The chest radiography shows cardiac enlargement and signs of pulmonary congestion. (C) The echocardiography in the long-axis, M mode shows an increased left ventricular end-diastolic diameter (5.0 cm) and reduced EF (43%). (D) Doppler ultrasound shows moderate mitral regurgitation and severe tricuspid regurgitation.