Primary hypoparathyroidism presenting with heart failure and ventricular fibrillation

Abstract

A 24-year-old female presented with sudden heart failure and ventricular fibrillation. A complete work-up suggested the existence of primary hypoparathyroidism in an otherwise previously healthy young woman. Left ventricle enlargement was detected by echocardiography with an ejection fraction of 30%. Electrolyte disorders dominated the laboratory results, with severe hypocalcemia, hypokalemia, hypomagnesemia and other changes, which were corrected with infusion therapy. An improvement of her overall condition prompted a switch from electrolyte infusion therapy to the oral route after the first week of treatment. The patient was discharged under calcium, calcitriol, diuretics and angiotensin-converting-enzyme-inhibitors oral maintenance therapy. Two months after discharge, her ejection fraction remained low (33%), although the end-systolic volume had returned to normal values, and her general status had substantially improved. Within a period of 4 months her cardiac function improved significantly and the follow-up surveillance echocardiography showed an ejection fraction of 53%, with normal left ventricle dimensions.

Diagnosis and treatment of hypoparathyroidism: a position statement from the Brazilian Society of Endocrinology and Metabolism

“…In addition, acute and severe hypocalcemia can potentially lead to sudden dyspnea followed by laryngeal stridor, characterizing laryngospasm (91), or result in papilledema associated or not with increased intracranial pressure. All these situations are reversible with normalization of serum calcium levels (C) (92,93).…”

A reversible hypocalcemic dilated cardiomyopathy caused by primary hypoparathyroidism

“…Myocardial dysfunction due to hypocalcemia has been documented in many experimental animal studies, and also in various clinical reports. [2][3][4][5][6][7][8][9][10] The role of calcium in heart muscle contraction and relaxation is well established. 11 Calcium inside the sarcoplasmic reticulum of the myocardial cells initiates contraction after binding to the troponin-tropomyosin complex resulting in the crosslinkage between the muscle proteins actin and myosin.…”

Insuficiencia cardiaca secundaria a hipocalcemia asociada a hipoparatiroidismo: reporte de un caso

“…Mientras más temprano se realice el diagnóstico y se implementa la terapéutica adecuada, se ha observado mejores resultados en la reversibilidad del cuadro [14]. En el caso de nuestra paciente, la prolongación del intervalo Q-T aumentaba el riesgo de muerte súbita; por lo que para prevenir aquello, se decidió la colocación de un cardiodesfibrilador implantable, con lo cual se consiguió mejoría en el electrocardiograma; no obstante, no se evidenció una recuperación adecuada de la fracción de eyección luego de 6 meses de tratamiento con la reposición de calcio, lo cual constituye un factor de mal pronóstico [15].…”