Hypercalcemic crisis and primary hyperparathyroidism: Cause of an unusual electrical storm

Primary hyperparathyroidism and recurrent ventricular tachyarrhythmia in a patient with novel RyR2 variant but without structural heart disease

“…In some of the patient cases reported, the plasma level calcium was very high, 5,8 while in others only moderately increased. 4,9,10 In our patient, the first blood analysis showed moderate hypercalcemia although PTH level was not severely elevated 28.8 pmol/L (1.6-6.9).…”

“…It was not described whether structural heart disease was present. In most previously reported cases, patients were known with conditions associated with increased risk of ventricular tachyarrhythmia such as dilated cardiomyopathy, prior myocardial infarction with left ventricular ejection fraction of 30%, significant general atherosclerosis with previous history of stroke or hypercalcemia combined with severely decreased level of potassium . Both monomorphic VT and polymorphic VT/VF have been described with severe PHPT.…”

“…In most previously reported cases, patients were known with conditions associated with increased risk of ventricular tachyarrhythmia such as dilated cardiomyopathy, prior myocardial infarction with left ventricular ejection fraction of 30%, significant general atherosclerosis with previous history of stroke or hypercalcemia combined with severely decreased level of potassium . Both monomorphic VT and polymorphic VT/VF have been described with severe PHPT. In 2000, Chang et al described a case in a patient with no history of heart disease, normal left ventricular function, and normal coronary arteries, where the clinical monomorphic VT could be induced during electrophysiological study after infusion of Calcium Gluconate.…”

Primary Hyperparathyroidism in a Post-total Thyroidectomy Patient: An Unexpected Diagnosis

“…Psychiatric and cardiovascular manifestations may also occur and calcium values >15 mg/dL are even associated with an increased risk of cardiac arrest [ 1 , 7 ]. In this case, there were renal alterations due to dehydration (worsening of creatinine compared to baseline values, with increased nitrogen retention); gastrointestinal symptoms, such as abdominal pain, nausea, vomiting, and constipation; neuromuscular, classified as a sensory, symmetrical and distal polyneuropathy (which denotes chronicity) and cardiovascular manifestations, as the electrocardiogram showed prolongation of the PR segment - The syncope episode may have resulted from the synergism of volume depletion and the potential arrhythmogenic effect associated with hypercalcemia or simply represent a case of autonomic dysfunction, attributable to normal aging process [ 3 , 4 , 7 , 9 , 10 ]. The skeletal manifestations, characterized by the typical radiological characteristics of salt and pepper seen in the skull, and periosteal reabsorption of the distal phalanges, were not observed (Figure 3 ) [ 4 ].…”

Clues to Bradycardia in a Psychiatric Patient can be Revealed by Good History-Taking: A Case Report and Literature Review

“…The observation that exogenous PTH induces necrosis of rat myocytes raises the possibility that hyperparathyroidism may directly induce SA node dysfunction [ 1 , 2 ] . In addition, hyperparathyroidism can also cause hypercalcaemia, which is associated with prolongation of the PR segment and the QRS interval and hence shortening of the QT interval, which is usually associated with bradycardia [ 3 ] . Some case reports suggested AV node dysfunction secondary to chronic severe hypercalcaemia in malignancy patients [ 4 , 5 ] .…”