Letters to the Editor

Abstract

I was interested to read the article by Avery et al. on cardiac failure secondary to hypocalcaemia of nutritional osteomalacia' 1 '. This paper provides supporting data on the role of hypocalcaemia in the development of reversible heart failure. In this case report, the patient's electrocardiogram revealed sinus rhythm with a left bundle branch block. However, there is no mention of the ECG QT interval. We previously presented a case report of reversible impairment of myocardial function in hypoparathyroidism causing hypocalcaemia. We observed a very close inverse correlation between the QT time and left ventricular function, and a very close positive correlation between the serum calcium level and left ventricular function' 2 '.It would be very useful to know whether or not there is a similar close inverse correlation between the QT interval and left ventricular function in the case of left bundle branch block. The question is of practical importance as the authors postulated that their patient could have had hypocalcaemia 6 months previously, but that the serum calcium level had not been measured. A QT interval prolongation could also provide indirect data on hypocalcaemia in this case.The second major issue is that the echocardiographic data are missing. Thus, one cannot tell to what extent the cardiomegaly seen on the chest X-ray was due to cardiac dilatation alone, or whether any additional pericardial effusion contributed to some extent to the cardiomegaly.