HYPOCALCEMIC CARDIOMYOPATHY AS A CAUSE OF SEVERE LEFT-VENTRICULAR FAILURE

25-year-old man was hospitalized because of dyspnoea and retrosternal pain. There were clinical and radiological signs of severe left ventri cular failure which within a few hours necessitated artificial ventila tion. A year before he had been diagnosed as having pseudohyperparathy roidism and disseminated encephalomyelitis. Administration of calcium and vitamin D was only partially efficacious. On admission the calcium concentration was 1.5 mmol/l. The severe left ventricular failure did not respond adequately to the usual therapeutic measures including ar tificial ventilation and catecholamines. A cumulative dose of about 50 mmol calcium was administered intravenously over 10 days, but marked improvement in myocardial function already became apparent at a calciu m concentration of about 1.8 mmol/l. Lasting correction of the hypocal caemia was achieved with 0.5 g calcium three times daily by mouth and 0.5 mg/d dihydrotachysterol. After transfer to a special neurological department because of an acute attack of multiple sclerosis there was no detectable impairment of cardiac function. - This case demonstrates that hypocalcaemic cardiomyopathy should be considered in the differe ntial diagnosis of heart failure in previously well young persons who do not respond adequately to the usual treatment. Myocardial impairmen t is fully reversible after administration of calcium.