Tertiary hyperparathyroidism associated with metastatic cardiac calcification in a haemodialyzed patient

Abstract

A 32-year-old man undergoing haemodialysis treatment for 10 years was referred to our hospital because of intractable heart failure with atrioventricular block. On the 5th hospital day he was found dead in bed. Autopsy revealed extensive metastatic calcification involving the myocardium and the cardiac conduction system, and a parathyroid adenoma with hyperplastic parathyroid glands. Retrospectively, first-degree heart block developed 14 months before death, and was subsequently associated with intraventricular conduction defect and atrioventricular block (Wenckebach type). Throughout the 3 years the patient received 1 alpha-hydroxycholecalciferol (1 alpha-OH-D3) and the calcium-phosphorus product (Ca X P) exceeded 70. 1 alpha-OH-D3 should not be prescribed when patients develop an increase in Ca X P and exploration of the parathyroid glands should not be delayed if heart block presents in long-term haemodialyzed patients.

Complete atrioventricular block during renal transplantation in a patient with Alport's syndrome: case report

“…6 Among the factors postulated to promote the development of metastatic calcification, both elevated calcium-phosphorus product and increased parathyroid hormone levels are possible, and exploration or removal of the parathyroid glands should be considered if heart block is present. 7 Another factor that influences cardiac conduction is serum potassium level. For levels above 7.0 mEq/l, intraventricular conduction velocity is usually decreased and the QRS complex widens.…”

The Harder the Heart, the Harder It Breaks: A Case of Complete Atrioventricular Block Secondary to Tertiary Hyperparathyroidism

“…We conclude that the elevated PTH could be the driving force of calcium deposition in the mitral annulus in the absence of high calcium and elevated Ca x P. Prior case reports have demonstrated the reversal of AV block after parathyroidectomy [12,13]. However, there is a lack of evidence supporting early parathyroidectomy after first-degree AV block's appearance in long-term hemodialysis patients with secondary/tertiary hyperparathyroidism.…”

Reversal of complete atrioventricular block in dialysis patients following parathyroidectomy: A case report

“…Notably, an early case report by Dreher et al [ 4 ] in 1975 demonstrated complete recovery of first-degree atrioventricular block following complete PTX in an end-stage hemodialysis patient with cardiac metastatic calcification. Similarly, Fujimoto et al [ 5 ] reported the case of a hemodialysis patient with third-degree SHPT and metastatic calcification resulting in atrioventricular block who died with extensive metastases despite hospitalization. Anam et al [ 3 ] recently described a case of CAVB secondary to severe hyperparathyroidism in a dialysis patient, highlighting the importance of suspecting metastatic cardiac calcification in cases of end-stage renal failure with elevated parathyroid hormone levels and concomitant first-degree atrioventricular conduction block and mitral annular calcification.…”