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A rare cause of dilated cardiomyopathy: hypocalcemia

Ummu Mutlu1, Ramazan Cakmak2, Mehmet Rasih Sonsöz3

  • 1Istanbul University, Istanbul Faculty of Medicine, Department of Endocrinology and Metabolism, Istanbul, Turkey, ukorkmaz18@gmail.com.

Archives of Endocrinology and Metabolism
|May 13, 2022
PubMed

Insights

Hypocalcemia can cause reversible dilated cardiomyopathy (DCM) and heart failure. Prompt calcium replacement and heart failure treatment significantly improved cardiac function in two patients with hypocalcemia-induced DCM.

Area of Science:

  • Cardiology
  • Endocrinology
  • Internal Medicine

Background:

  • Dilated cardiomyopathy (DCM) is typically idiopathic and involves systolic dysfunction.
  • Hypocalcemia, a rare cause of reversible DCM, impairs myocardial contraction.
  • Calcium is crucial for myocardial contractility, and its deficiency can lead to heart failure with reduced ejection fraction (EF).

Observation:

  • Two cases of heart failure due to hypocalcemia secondary to hypoparathyroidism are presented.
  • Case 1: Idiopathic hypoparathyroidism with severe heart failure and serum calcium of 4.4 mg/dL.
  • Case 2: Iatrogenic hypoparathyroidism post-thyroidectomy with heart failure and hypocalcemia.

Findings:

  • Both patients presented with reduced left ventricular systolic function (EF 33% and 42%).
  • Following calcium replacement and heart failure management, calcium levels normalized.
  • Significant and rapid improvement in heart failure symptoms and EF (to 60% and 50%) was observed.

Implications:

  • Serum calcium levels should be routinely measured in heart failure patients.
  • Investigating the etiology of hypocalcemia is crucial for effective treatment.
  • Calcium supplementation is essential alongside standard heart failure therapy for hypocalcemia-related DCM.

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