A case of massive dystrophic cardiac calcinosis with increased bone resorption markers: a novel pathophysiologic link?
We report a 72-year-old man who presented to our emergency room with congestive heart failure that was resistant to initial medical therapy. He had suffered from anterior myocardial infarction 20 years prior. Echocardiography and computed tomography revealed marked cardiac calcification including myocardium, chordal structures, mitral annulus, and aortic valve. Neither chronic renal insufficiency nor hypercalcemia were present in our patient. Bone resorption markers were increased and bone mineral density was consistent with severe osteoporosis. We suggested a novel mechanism, that increased bone resorption may lead to accumulation of calcium into avascular tissues in the heart (ie, chordal structures, mitral annulus, aortic valve, and fibronecrotic myocardium) especially in the setting of high left ventricular end-diastolic pressure. Dystrophic cardiac calcinosis, an age-related cardiomyopathy, is associated with elevated bone resorption markers and it may cause alterations in cellular calcium hemostasis with initiation of deleterious events leading to aggravate dilated and restrictive cardiomyopathy and may result in intractable congestive heart failure. The implication of this case report needs to be reemphasized.
Department of Cardiology, Sahinbey Medical Center, Gaziantep University, Gaziantep, Turkey. davutoglu@gantep.edu.tr
Vedat
V
Davutoglu
Selim
S
Kervancioglu
Yusuf
Y
Sezen
Nurullah
N
Gunay
D000368:Aged; D001862:Bone Resorption / Q000503:physiopathology*; D002114:Calcinosis / Q000503:physiopathology*; D009202:Cardiomyopathies / Q000503:physiopathology*; D006333:Heart Failure / Q000503:physiopathology; D006801:Humans; D008297:Male; D010024:Osteoporosis / Q000503:physiopathology; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology; D017725:Ventricular Pressure