Ionized Calcium, the Heart, and Hemodynamic Function

Drop, Lambertus J.

doi:10.1213/00000539-198504000-00011

Cited by 81 publications

(20 citation statements)

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“…Furthermore, the duration and amplitude of the calcium influx have been shown to affect the strength of cardiomyocyte contraction (6,21). Experimental studies demonstrated reduced cardiac contractility in hypocalcemic states, as evidenced by decreased LV performance and cardiac index (44,45), and suggested an increase in myocardial contractility and cardiac output with calcium correction (46,47). However, clinical heart failure in patients with hypocalcemia is rare, probably because it is a late complication, most commonly following the onset of neuromuscular irritability (15).…”

Section: Discussionmentioning

confidence: 99%

Use of recombinant human parathyroid hormone in hypocalcemic cardiomyopathy

Ballane

Sfeir

Dakik³

et al. 2012

European Journal of Endocrinology

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Hypocalcemia secondary to hypoparathyroidism is a rare cause of congestive heart failure. However, its early recognition and treatment lead to significant improvement in cardiac function. We report a middle-aged woman presenting with symptoms of heart failure with a serum calcium level of 3.7 mg/dl and a serum inorganic phosphate level of 17.6 mg/dl 22 years after subtotal thyroidectomy. Besides calcium and calcitriol supplementation, she was the first patient with severe hypocalcemic cardiomyopathy to be given off-label recombinant human parathyroid hormone (PTH) because of an elevated serum calcium–phosphate product. We discuss the management and outcome of the patient and then present a brief review of similar previously reported cases. We also describe the pivotal role of calcium ion and the potential role of PTH in maintaining myocardial contractility, effective natriuresis, and possible pathogenic mechanisms contributing to heart failure secondary to hypocalcemia and hypoparathyroidism.

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Section: Discussionmentioning

confidence: 99%

Use of recombinant human parathyroid hormone in hypocalcemic cardiomyopathy

Ballane

Sfeir

Dakik³

et al. 2012

European Journal of Endocrinology

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“…At modest cardiac work, no effects of hypocalcemia can be observed, because Ca 2+ is present in excess. Under stress, however, the deficiency of Ca 2+ becomes apparent [80]. Hemodynamic profiles during load with citrate show a decrease of the cardiac index at sufficient filling pressure in combination with a decrease of the levels of free Ca 2+ in serum at elevated citrate levels [81].…”

Section: Effects Of Hypocalcemiamentioning

confidence: 99%

Massive Transfusion and Its Influence on Oxygen Transport and Electrolyte Balance

Schmitt¹,

Lackes²

2000

Transfus Med Hemother

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During the process of storing erythrocyte-containing blood products, components of the preservatives and modifications of the erythrocyte function cause disorders of the electrolyte and acid-base balance as well as a deficiency of 2,3-diphosphoglycerate (2,3-DPG). Thereby transitory hyperkalemias may occur in the course of a massive transfusion, if the patient has a shock or another disturbance of the regulating mechanisms caused by diabetes mellitus or a treatment with β-blockers or ACE inhibitors. During the treatment with blood components, hypocalcemia and hypomagnesemia may develop after a dose of more than 12 fresh frozen plasms (FFP) per hour, if the metabolism of citrate, which binds bivalent cations as a chelate, is disturbed by hypothermia, shock or during the anhepatic stage of a liver transplantation. As a consequence, a low-output syndrome as well as tachyarrhythmias and torsades de pointes may develop. Whether the decrease of the 2,3-DPG level with the accompanying leftward shift of the oxyhemoglobin dissociation curve brings about a deficiency of the oxygen supply of the organs, has not yet been verified by experiment. The studies presented rather point at morphological changes of the erythrocytes due to the storage as the cause of the disturbances of capillary perfusion. For this reason patients with impending organ failure or marked disturbances of the coronary or cerebral perfusion should be transfused with packed red blood cells (RBCs) not older than 14 days.

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“…Low serum calcium levels can also induce arrhythmias (specifically shortening of the electrocardiographic QT interval). Hypocalcaemia can lead to severe cardiovascular depression [26,27] and congestive heart failure that is unresponsive to inotropic agents, especially in patients with underlying cardiomyopathies [28,29]. These cardiovascular effects may occur in the absence of specific electrocardiographic changes.…”

Section: Introductionmentioning

confidence: 99%

Severe electrolyte disorders following cardiac surgery: a prospective controlled observational study

Polderman

Girbes

2004

Crit Care

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Introduction Electrolyte disorders are an important cause of ventricular and supraventricular arrhythmias as well as various other complications in the intensive care unit. Patients undergoing cardiac surgery are at risk for development of tachyarrhythmias, especially in the period during and immediately after surgical intervention. Preventing electrolyte disorders is thus an important goal of therapy in such patients. However, although levels of potassium are usually measured regularly in these patients, other electrolytes such as magnesium, phosphate and calcium are measured far less frequently. We hypothesized that patients undergoing cardiac surgical procedures might be at risk for electrolyte depletion, and we therefore conducted the present study to assess electrolyte levels in such patients. Methods Levels of magnesium, phosphate, potassium, calcium and sodium were measured in 500 consecutive patients undergoing various cardiac surgical procedures who required extracorporeal circulation (group 1). A total of 250 patients admitted to the intensive care unit following other major surgical procedures served as control individuals (group 2). Urine electrolyte excretion was measured in a subgroup of 50 patients in both groups. Results All cardiac patients received 1 l cardioplegia solution containing 16 mmol potassium and 16 mmol magnesium. In addition, intravenous potassium supplementation was greater in cardiac surgery patients (mean ± standard error: 10.2 ± 4.8 mmol/hour in cardiac surgery patients versus 1.3 ± 1.0 in control individuals; P < 0.01), and most (76% versus 2%; P < 0.01) received one or more doses of magnesium (on average 2.1 g) for clinical reasons, mostly intraoperative arrhythmia. Despite these differences in supplementation, electrolyte levels decreased significantly in cardiac surgery patients, most of whom (88% of cardiac surgery patients versus 20% of control individuals; P < 0.001) met criteria for clinical deficiency in one or more electrolytes. Electrolyte levels were as follows (mmol/l [mean ± standard error]; cardiac patients versus control individuals): phosphate 0.43 ± 0.22 versus 0.92 ± 0.32 (P < 0.001); magnesium 0.62 ± 0.24 versus 0.95 ± 0.27 (P < 0.001); calcium 1.96 ± 0.41 versus 2.12 ± 0.33 (P < 0.001); and potassium 3.6 ± 0.70 versus 3.9 ± 0.63 (P < 0.01). Magnesium levels in patients who had not received supplementation were 0.47 ± 0.16 mmol/l in group 1 and 0.95 ± 0.26 mmol/l in group 2 (P < 0.001). Urinary excretion of potassium, magnesium and phosphate was high in group 1 (data not shown), but this alone could not completely account for the observed electrolyte depletion. Conclusion Patients undergoing cardiac surgery with extracorporeal circulation are at high risk for electrolyte depletion, despite supplementation of some electrolytes, such as potassium. The probable mechanism is a combination of increased urinary excretion and intracellular shift induced by a combination of extracorporeal circulation and decreased body temperature during surgery (hypothermia ...

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Ionized Calcium, the Heart, and Hemodynamic Function

Cited by 81 publications

References 0 publications

Use of recombinant human parathyroid hormone in hypocalcemic cardiomyopathy

Use of recombinant human parathyroid hormone in hypocalcemic cardiomyopathy

Massive Transfusion and Its Influence on Oxygen Transport and Electrolyte Balance

Severe electrolyte disorders following cardiac surgery: a prospective controlled observational study

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