title: Heart Failure Associated with Metastatic Myocardial Calcification in a Hemodialysis Patient with Progressive Calcification of the Hand.
abstract: Metastatic myocardial calcification is a frequent cause of heart failure in hemodialysis patients. However, early detection is difficult, often resulting in a poor prognosis. A 47-year-old man with hemodialysis-dependent end-stage renal disease presented with progressive dyspnea. Levels of serum phosphate, calcium, and intact parathyroid hormone were poorly controlled. He developed pain in his right thumb 1 year before presentation, and the pain gradually increased and extended to the entire right hand. Hand radiography 1 month earlier had revealed significant progressive calcification. Echocardiography showed severe, diffuse hypokinesis and pericardial effusion as well as possible anterior myocardial calcification with high echogenicity. Chest computed tomography revealed a severely dilated heart with anterior massive myocardial calcification and a large amount of pericardial effusion, which was not detected on computed tomography performed 20 months earlier. The patient was diagnosed with heart failure associated with metastatic myocardial calcification and died suddenly 2 weeks later. This experience suggests that progressive metastatic calcification of the skin and subcutaneous tissue is useful for predicting myocardial calcification.
authors: First Department of Internal Medicine, Nara Medical University, Kashihara, Japan.
authors: Masaru
authors: M
authors: Matsui
authors: Satoshi
authors: S
authors: Okayama
authors: Akihiro
authors: A
authors: Takitsume
authors: Katsuhiko
authors: K
authors: Morimoto
authors: Kenichi
authors: K
authors: Samejima
authors: Shiro
authors: S
authors: Uemura
authors: Yoshihiko
authors: Y
authors: Saito
references: Am J Med. 1988 Nov;85(5):651-7
references: 3055977
references: Am J Kidney Dis. 2000 May;35(5):E27
references: 10793056
references: Rev Esp Cardiol. 2007 Oct;60(10):1092
references: 17953931
references: Clin Nephrol. 2005 Apr;63(4):313-6
references: 15847261
references: Am J Pathol. 1977 Feb;86(2):403-24
references: 836675
references: AJR Am J Roentgenol. 1987 Nov;149(5):881-7
references: 3499790
references: Clin Transplant. 2002;16 Suppl 8:58-61
references: 12464134
references: J Forensic Sci. 2000 Nov;45(6):1335-8
references: 11110195
references: Kidney Int. 2006 Jun;69(11):1945-53
references: 16641930
references: J Hosp Med. 2009 Jul;4(6):E16
references: 19670376
references: Eur Radiol. 2013 Feb;23(2):360-6
references: 22892722
references: Cardiovasc Pathol. 2011 Mar-Apr;20(2):e79-83
references: 20598909
references: J Cardiovasc Comput Tomogr. 2010 Nov-Dec;4(6):402-4
references: 21030332