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Hypocalcemic heart failure masquerading as dilated cardiomyopathy.
1Departments of Pediatrics, All India Institute of Medical Sciences, New Delhi.
Indian Journal of Pediatrics
|May 8, 2001
Summary
Hypocalcemia, a rare cause of heart failure in infants, can be reversed with treatment. This case highlights the importance of recognizing low calcium levels in children with cardiac symptoms.
Area of Science:
- Pediatric Cardiology
- Pediatric Endocrinology
- Biochemistry
Background:
- Congestive heart failure (CHF) in infants can stem from various causes, including rare metabolic conditions.
- Dilated cardiomyopathy and prolonged QT interval (QoTc) are serious cardiac findings in children.
- Rickets, characterized by bone deformities, can be associated with calcium and vitamin D deficiencies.
Observation:
- A 4-month-old infant presented with dilated cardiomyopathy, prolonged QoTc, and biochemical evidence of rickets (low calcium, normal phosphate, high alkaline phosphatase).
- Initial treatment with calcium and vitamin D3 was ineffective, suggesting a more complex underlying condition.
- A diagnosis of Vitamin D-dependent rickets type I (VDDR I) was suspected.
Findings:
- Treatment with calcium and calcitriol led to rapid normalization of serum calcium levels within 10 days.
- The infant's cardiac function improved significantly, with resolution of heart failure symptoms and QoTc normalization.
- Biochemical markers normalized, indicating successful management of the underlying metabolic disorder.
Implications:
- Hypocalcemia should be considered a potentially reversible cause of heart failure and cardiac dysfunction in pediatric patients.
- Early diagnosis and appropriate treatment of metabolic disorders like VDDR I are crucial for reversing cardiac complications.
- Pediatricians must maintain a high index of suspicion for metabolic causes of pediatric heart failure.