Hypocalcemic Rachitic Cardiomyopathy in Infants

Overview

Journal J Saudi Heart Assoc

Specialty Cardiology & Vascular Diseases

Date 2013 Nov 1

PMID 24174842

Citations 14

Authors

Abdelwahab T H Elidrissy

Medinah Munawarah

Khalid M AlHarbi

Affiliations

Soon will be listed here.

Abstract

Unlabelled: Hypocalcemic cardiomyopathy in infants is characterized by heart failure in a previously normal infant with hypocalcemia without organic cardiac lesion. Vitamin D deficiency rickets is increasing in Middle East. In a six month study 136 cases of rickets were diagnosed in the main Children's Hospital in Almadinah but none of them showed evidence of cardiomyopathy. Concerned of missing this serious complication of rickets we searched pub med and present this review article.

Results: 61 cases of hypocalcemic cardiomyopathy were reported as case reports with two series of 16 and 15 cases from London and Delhi, respectively. The major features of these cases: the age ranged from one month to 15 months with a mean age of 5 months. All presented with heart failure and hypocalcemia. There was a minor feature of rickets in a few of the cases. All had high alkaline phosphatase. Echocardiology evidence of cardiomyopathy was found in all. Most of them responded to calcium, vitamin D and cardiotonic and diuretics.

Discussion: We concentrated on pathogenesis of this hypocalcemic cardiomyopathy and reviewed the literature. The evidence available supports that the most likely cause of cardiomyopathy is hypocalcemia. Hypovitamin D also contributes but hyperparathyroidism might have a protective role as we did not detect any evidence of cardiomyopathy with hyperparathyroidism and florid features of rickets.

Conclusion: We need to look out for cardiomyopathy among infants with hypocalcemia. For prevention maternal supplementation during pregnancy and lactation with up to 2000 units of vitamin D and 400 units for their infants.

Citing Articles

Vitamin D Deficiency, Chronic Kidney Disease and Periodontitis.

Ganimusa I, Chew E, Lu E Medicina (Kaunas). 2024; 60(3).

PMID: 38541146 PMC: 10972110. DOI: 10.3390/medicina60030420.

Cardiac dysfunction in severe pediatric acute respiratory distress syndrome: the right ventricle in search of the right therapy.

Webb L, Burton L, Manchikalapati A, Prabhakaran P, Loberger J, Richter R Front Med (Lausanne). 2023; 10:1216538.

PMID: 37654664 PMC: 10466806. DOI: 10.3389/fmed.2023.1216538.

Clinical Profile, Intensive Care Needs and Outcome of Children with Dilated Cardiomyopathy Associated with Vitamin D Deficiency: A 5-year PICU Experience.

Kumar S, Randhawa M, Angurana S, Nallasamy K, Bansal A, Kumar M Indian J Crit Care Med. 2023; 27(7):510-514.

PMID: 37502290 PMC: 10369324. DOI: 10.5005/jp-journals-10071-24484.

Is Hypovitaminosis D a Risk Factor for Heart Failure?.

Hagau A, Puscas A, Toganel R, Muntean I Life (Basel). 2023; 13(2).

PMID: 36836729 PMC: 9967471. DOI: 10.3390/life13020372.

Vitamin D and Cardiovascular Disease: An Updated Narrative Review.

Zittermann A, Trummer C, Theiler-Schwetz V, Lerchbaum E, Marz W, Pilz S Int J Mol Sci. 2021; 22(6).

PMID: 33809311 PMC: 7998446. DOI: 10.3390/ijms22062896.

References

Verma S, Khadwal A, Chopra K, Rohit M, Singhi S . Hypocalcemia nutritional rickets: a curable cause of dilated cardiomyopathy. J Trop Pediatr. 2010; 57(2):126-8. DOI: 10.1093/tropej/fmq044. View

Goulet M, Rio M, Jacquette A, Ladouceur M, Bonnet D . [Neonatal hypocalcaemic dilated myocardiopathy due to a 22q11 microdeletion]. Arch Mal Coeur Vaiss. 2006; 99(5):520-2. View

Karademir S, Altuntas B, Tezic T, Akinci A, Demirceken F . Left ventricular dysfunction due to hypocalcemia in a neonate. Jpn Heart J. 1993; 34(3):355-9. DOI: 10.1536/ihj.34.355. View

Cramm K, Cattaneo R, Schremmer R . An infant with tachypnea. Pediatr Emerg Care. 2006; 22(11):728-31. DOI: 10.1097/01.pec.0000238746.81358.ae. View

Andersson P, Rydberg E, Willenheimer R . Primary hyperparathyroidism and heart disease--a review. Eur Heart J. 2004; 25(20):1776-87. DOI: 10.1016/j.ehj.2004.07.010. View

Serenius F, Elidrissy A, Dandona P . Vitamin D nutrition in pregnant women at term and in newly born babies in Saudi Arabia. J Clin Pathol. 1984; 37(4):444-7. PMC: 498748. DOI: 10.1136/jcp.37.4.444. View

Abdullah M, Bigras J, McCrindle B, Mustafa A . Dilated cardiomyopathy as a first sign of nutritional vitamin D deficiency rickets in infancy. Can J Cardiol. 1999; 15(6):699-701. View

Bashour T, Basha H, Cheng T . Hypocalcemic cardiomyopathy. Chest. 1980; 78(4):663-5. DOI: 10.1378/chest.78.4.663. View

Kumar M, Saikia D, Kumar V, Tomar R . Vitamin D deficiency presenting with cardiogenic shock in an infant. Ann Pediatr Cardiol. 2011; 4(2):207-9. PMC: 3180989. DOI: 10.4103/0974-2069.84668. View

10.

Maiya S, Sullivan I, Allgrove J, Yates R, Malone M, Brain C . Hypocalcaemia and vitamin D deficiency: an important, but preventable, cause of life-threatening infant heart failure. Heart. 2007; 94(5):581-4. DOI: 10.1136/hrt.2007.119792. View

11.

Roy R, El-Matary W, Gladman G, Isherwood D . Dilated cardiomyopathy and adipic aciduria in nutritional rickets. Pediatr Emerg Care. 2006; 22(3):175-6. DOI: 10.1097/01.pec.0000202460.57355.77. View

12.

Kim B, Chang S, Kim S, Hwang J, Jung J . Dilated cardiomyopathy in a 2 month-old infant: a severe form of hypocalcemia with vitamin d deficient rickets. Korean Circ J. 2010; 40(4):201-3. PMC: 2859339. DOI: 10.4070/kcj.2010.40.4.201. View

13.

Cox G, Sleeper L, Lowe A, Towbin J, Colan S, Orav E . Factors associated with establishing a causal diagnosis for children with cardiomyopathy. Pediatrics. 2006; 118(4):1519-31. DOI: 10.1542/peds.2006-0163. View

14.

Gupta P, Tomar M, Radhakrishnan S, Shrivastava S . Hypocalcemic cardiomyopathy presenting as cardiogenic shock. Ann Pediatr Cardiol. 2011; 4(2):152-5. PMC: 3180974. DOI: 10.4103/0974-2069.84655. View

15.

Deo R, Katz R, Shlipak M, Sotoodehnia N, Psaty B, Sarnak M . Vitamin D, parathyroid hormone, and sudden cardiac death: results from the Cardiovascular Health Study. Hypertension. 2011; 58(6):1021-8. PMC: 3337033. DOI: 10.1161/HYPERTENSIONAHA.111.179135. View

16.

EDGE W . HYPOCALCAEMIA IN INFANCY, WITH SPECIAL REFERENCE TO CARDIAC FAILURE. S Afr Med J. 1963; 37:262-4. View

17.

Ozerkan F, Gungor H, Zoghi M, Nalbantgil S . [Cardiac failure secondary to idiopathic hypoparathyroidism: a case report]. Turk Kardiyol Dern Ars. 2009; 37(1):53-6. View

18.

Carlton-Conway D, Tulloh R, Wood L, Kanabar D . Vitamin D deficiency and cardiac failure in infancy. J R Soc Med. 2004; 97(5):238-9. PMC: 1079465. DOI: 10.1177/014107680409700508. View

19.

Elidrissy A, Sedrani S, LAWSON D . Vitamin D deficiency in mothers of rachitic infants. Calcif Tissue Int. 1984; 36(3):266-8. DOI: 10.1007/BF02405328. View

20.

Judd S, Tangpricha V . Vitamin d therapy and cardiovascular health. Curr Hypertens Rep. 2011; 13(3):187-91. DOI: 10.1007/s11906-011-0190-2. View