Yilmaz Osman, Olgun Hasim, Ciftel Murat, Kilic Omer, Kartal Ibrahim, Iskenderoglu Nebahat Y, Laloglu Fuat, Ceviz Naci
1Department of Pediatric Cardiology,Erzurum District Training and Research Hospital,Erzurum,Turkey.
2Department of Pediatrics,Division of Pediatric Cardiology,Ataturk University Medical Faculty,Erzurum,Turkey.
Cardiol Young. 2015 Feb;25(2):261-6. doi: 10.1017/S1047951113002023. Epub 2013 Dec 17.
Dilated cardiomyopathy is usually idiopathic and may arise secondary to infections or metabolic or genetic causes. Another rare cause is hypocalcaemia. Owing to the fact that calcium plays an essential role in excitation and contraction of myocardial muscle, myocardial contractility may decline in patients with hypocalcaemia.
Patients with symptoms of congestive heart failure and rickets-related hypocalcaemia were assessed clinically and by echocardiography in a paediatric cardiology clinic. Echocardiography was performed for all patients. Rickets was diagnosed according to the clinical, laboratory, and radiologic findings. Maternal lifestyle and living conditions were investigated, and the maternal 25-OH vitamin D3 blood level was measured.
We evaluated eight patients who developed heart failure as a result of severe hypocalcaemia associated with rickets between August, 1999 and June, 2012. The age distribution of the patients was 3-12 months. Laboratory results were consistent with advanced-stage rickets. Severe hypocalcaemia was detected in all patients. The maternal 25-OH vitamin D3 levels were low. Echocardiography revealed increased pre-treatment left ventricle end-systolic and end-diastolic diameters for age and reduced ejection fraction and fractional shortening. After clinical improvement, the patients were discharged.
Severe hypocalcaemia associated with rickets must always be kept in mind among the causes of dilated cardiomyopathy and impaired cardiac function in infants. If diagnosed and treated in time, dilated cardiomyopathy and severe heart failure related to rickets respond well.
扩张型心肌病通常为特发性，也可能继发于感染、代谢或遗传因素。另一个罕见病因是低钙血症。由于钙在心肌的兴奋和收缩中起关键作用，低钙血症患者的心肌收缩力可能会下降。
在儿科心脏病诊所，对有充血性心力衰竭症状和与佝偻病相关的低钙血症患者进行临床评估和超声心动图检查。对所有患者均进行了超声心动图检查。根据临床、实验室和影像学检查结果诊断佝偻病。调查产妇的生活方式和生活条件，并测量产妇血清25-羟基维生素D3水平。
我们评估了1999年8月至2012年6月期间因严重低钙血症合并佝偻病而发生心力衰竭的8例患者。患者年龄分布为3至12个月。实验室检查结果与晚期佝偻病相符。所有患者均检测到严重低钙血症。产妇血清25-羟基维生素D3水平较低。超声心动图显示，治疗前左心室收缩末期和舒张末期直径超过年龄预期值，射血分数和缩短分数降低。临床症状改善后，患者出院。
婴儿扩张型心肌病和心功能受损的病因中，必须始终考虑到与佝偻病相关的严重低钙血症。如果及时诊断和治疗，与佝偻病相关的扩张型心肌病和严重心力衰竭的治疗效果良好。
