Isotalo P A, Halil A, Green M, Tang A, Lach B, Veinot J P
Department of Pathology and Laboratory Medicine, University of Ottawa, Ontario, Canada.
J Forensic Sci. 2000 Nov;45(6):1335-8.
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 cardiac morbidity and mortality. We describe a 40-year-old man with Von Hippel-Lindau disease who had been maintained on hemodialysis for two years following bilateral nephrectomies for renal cell carcinoma. The patient presented with symptomatic complete heart block that had progressed from Mobitz type I atrioventricular block. Two months later, while being internally paced, the patient died unexpectedly after a complicated hospital admission. Postmortem revealed extensive vascular, myocardial, and conduction system calcification. Conduction system calcification may cause sudden death in chronic renal failure patients during hospital admission, or unexpectedly while the patient is in the community. Knowledge of this condition is necessary to detect it, as the conduction system is not routinely examined. A routine abbreviated conduction system examination is warranted for patients with systemic metastatic calcification, especially if they have sudden death or a known history of heart block.
系统性转移性钙化是慢性肾衰竭的常见并发症。心脏受累尤其凶险，特别是当心脏传导系统受到影响时。传导系统钙化已被报道可导致传导障碍、心律失常和猝死；然而，这些都是相对报道不足或未被认识到的心脏发病和死亡原因。我们描述了一名40岁患有冯·希佩尔－林道病的男性，他因肾细胞癌接受双侧肾切除术后接受了两年的血液透析治疗。该患者出现有症状的完全性心脏传导阻滞，此症状由莫氏I型房室传导阻滞进展而来。两个月后，患者在接受心脏起搏器植入时，在住院过程中出现并发症后意外死亡。尸检显示广泛的血管、心肌和传导系统钙化。传导系统钙化可能导致慢性肾衰竭患者在住院期间突然死亡，或在患者身处社区时意外死亡。由于传导系统通常不会进行常规检查，因此了解这种情况对于检测它很有必要。对于患有系统性转移性钙化的患者，尤其是那些有猝死或已知心脏传导阻滞病史的患者，进行常规的简略传导系统检查是有必要的。
