Pa. Isotalo et al., Metastatic calcification of the cardiac conduction system with heart block: An under-reported entity in chronic renal failure patients, J FOREN SCI, 45(6), 2000, pp. 1335-1338
Systemic metastatic calcification is a common complication of chronic renal
failure. Cardiac involvement is particularly ominous, especially when the
cardiac conduction system is affected. Conduction defects, arrhythmias, and
sudden death have all been reported with conduction system calcification;
however, these are relatively under-reported or unrecognized causes of card
iac morbidity and mortality. We describe a 40-year-old man with Von Hippel-
Lindau disease who had been maintained on hemodialysis for two years follow
ing bilateral nephrectomies for renal cell, carcinoma. The patient presente
d with symptomatic complete heart block that had progressed from Mobitz typ
e I atrioventricular block. Two months later, while being internally paced,
the patient died unexpectedly after a complicated hospital admission. Post
mortem revealed extensive vascular, myocardial, and conduction system calci
fication. Conduction system calcification may cause sudden death in chronic
renal failure patients during hospital admission, or unexpectedly while th
e patient is in the community. Knowledge of this condition is necessary to
detect it, as the conduction system is not routinely examined. A routine ab
breviated conduction system examination is warranted for patients with syst
emic metastatic calcification, especially if they have sudden death or a kn
own history of heart block.