Introduction: Calcium plays a key role in myocardial contractions and relaxation. Heart failure induced by hypocalcemia is rare but potentially reversible case.
Case report: We present the case of 50 years old woman with muscle cramps, cataract, chest pain and dyspnea that lasts 2 years. In regional health center she was treated as psychiatric patient and COPD. Last few months she became extremely malaise with crural edemas and walking distance of 100 m. She was referred to Clinic for Cardiology and rtg of chest show cardiomegaly and bilateral pleural effusion. ECG report show negative T waves between V1-6. CK levels were extremely high, while CKMB and troponin levels were normal. Echocardiography suggested systolic and diastolic dysfunction of both left and right ventricules with mitral and tricuspid regurgitation, while EF was 37%. Standardized therapy for heart failure was started but there was no clinical effect. Coronarography was normal. Endocrinologist was consulted due to high CK levels, clinical signs of hypocalcemia were observed and calcium (1.3 mmol/l) and PTH (6 ng/ml) levels suggested hypoparathyroidism. Substitution therapy with calcium and vitamin D was started. After 1 year of therapy patient was asymptomatic. Control echocardiography was performed and both systolic and diastolic function of ventricules were normal, EF was 51%.
Conclusion: In patients with heart failure calcium levels should be tested, especially if heart failure is refractory to therapy.
Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.
Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.