Hypocalcemic cardiomyopathy | Revista Portuguesa de Cardiologia (English edition)

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LA: left atrium; RA: right atrium. Right: ICE 2-chamber view after insertion of the ICE probe into the right ventricle (RV). Visualization of the mitral valve (white arrow) prior to percutaneous mitral balloon valvuloplasty. Left atrial enlargement and left ventricular function and dimensions can be assessed. (B) Percutaneous mitral balloon valvuloplasty. Angiographic and ICE visualization of the inflated Inoue balloon (white arrow). ICE catheter probe (large black arrow) is located in the RV and the pig-tail catheter (small black arrow) in the left ventricle. (C) Post-PMBV ICE assessment. Left: two-dimension assessment. 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Shortened PR interval, delta wave, widened QRS complex and secondary repolarization abnormalities are seen. This ECG is indicative of WPW syndrome, and a left lateral AP is suggested (positive delta wave in V1 and inferior leads and negative delta wave in aVL and DI).<a class="elsevierStyleCrossRef" href="#bib0065">13</a>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Guida Silva, Gustavo Pires de Morais, João Primo, Olga Sousa, Eulália Pereira, Marta Ponte, Lino Simões, Vasco Gama" "autores" => array:8 [ 0 => array:2 [ "nombre" => "Guida" "apellidos" => "Silva" ] 1 => array:2 [ "nombre" => "Gustavo Pires" "apellidos" => "de Morais" ] 2 => array:2 [ "nombre" => "João" "apellidos" => "Primo" ] 3 => array:2 [ "nombre" => "Olga" "apellidos" => "Sousa" ] 4 => array:2 [ "nombre" => "Eulália" "apellidos" => "Pereira" ] 5 => array:2 [ "nombre" => "Marta" "apellidos" => "Ponte" ] 6 => array:2 [ "nombre" => "Lino" "apellidos" => "Simões" ] 7 => array:2 [ "nombre" => "Vasco" "apellidos" => "Gama" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204913000998?idApp=UINPBA00004E" "url" => "/21742049/0000003200000004/v1_201308021404/S2174204913000998/v1_201308021404/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "Case report" "titulo" => "Hypocalcemic cardiomyopathy" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "331" "paginaFinal" => "335" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Patrício Aguiar, Diogo Cruz, Rita Ferro Rodrigues, Lígia Peixoto, Francisco Araújo, José Luís Ducla Soares" "autores" => array:6 [ 0 => array:4 [ "nombre" => "Patrício" "apellidos" => "Aguiar" "email" => array:1 [ 0 => "patricio_aguiar@yahoo.com.br" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "¿" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Diogo" "apellidos" => "Cruz" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Rita Ferro" "apellidos" => "Rodrigues" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "Lígia" "apellidos" => "Peixoto" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "Francisco" "apellidos" => "Araújo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] 5 => array:3 [ "nombre" => "José Luís" "apellidos" => "Ducla Soares" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Serviço de Medicina 1, Centro Hospitalar Lisboa Norte, EPE, Lisboa, Portugal" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Serviço de Doenças Infecciosas, Centro Hospitalar Lisboa Norte, EPE, Lisboa, Portugal" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Departamento de Medicina Interna, Hospital Beatriz Ângelo, Loures, Portugal" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Miocardiopatia hipocalcémica" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1483 "Ancho" => 1667 "Tamanyo" => 99909 ] ] "descripcion" => array:1 [ "en" => "Echocardiogram." ] ] ] "textoCompleto" => "IntroductionThe clinical syndrome of heart failure (HF) results from congenital or acquired alterations to cardiac structure and/or function that are manifested by an imbalance between cardiac output and tissue oxygen requirements.<a class="elsevierStyleCrossRefs" href="#bib0005">1,2</a>Among the different etiologies of HF are the cardiomyopathies, which are classified according to morphological type as dilated, restrictive and hypertrophic. Some forms of dilated cardiomyopathy, due to metabolic or toxic causes, are reversible (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).<a class="elsevierStyleCrossRef" href="#bib0015">3</a><elsevierMultimedia ident="tbl0005"></elsevierMultimedia>Calcium plays an essential role in myocardial metabolism, and hypocalcemia reduces myocardial contractility. However, HF of this etiology is rare, with few cases reported in the literature,<a class="elsevierStyleCrossRef" href="#bib0020">4</a> but in most of these cases, correction of hypocalcemia led to resolution of HF.Only one case has been reported in Portugal of dilated cardiomyopathy associated with post-surgical hypothyroidism, in which hypocalcemia, also in the context of post-surgical hypoparathyroidism, was the factor triggering decompensation of HF.<a class="elsevierStyleCrossRef" href="#bib0025">5</a>Case reportWe report the case of a 61-year-old woman from Brazil, where she had been a mathematics teacher, resident for around a year in Portugal, where she worked as a cleaner. She had a history of surgery for bilateral pseudophakia over 15 years previously; she reported no other previous conditions, relevant family history or cardiovascular risk factors, was taking no medication, and did not drink or smoke.She had been asymptomatic until three months before admission, when she began to experience worsening exertional dyspnea, associated with orthopnea in the three days before admission. She reported no paroxysmal nocturnal dyspnea, chest pain, palpitations, syncope, cough, expectoration or fever throughout this period.Due to symptoms on minimal exertion she went to the emergency department, where examination showed mental confusion, psychomotor slowing, depressed facial expression, blood pressure 97/59 mmHg, rhythmic heart rate 79 bpm, respiratory rate 28 cpm, thinning of the outer third of the eyebrows, limb tremor and muscle spasms, but no Chvostek or Trousseau sign. Crackling rales were audible in the lower half of both lung fields, as well as an S3 gallop and a grade I/VI systolic murmur more clearly audible in the mitral area. The rest of the physical exam was normal.Further diagnostic tests revealed normal myocardial necrosis markers, elevated BNP, rhabdomyolysis, severe hypocalcemia and type 1 respiratory failure (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>). The electrocardiogram (ECG) (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>) showed long QT interval (QTc 0.53 s) and T-wave inversion in V2–V4 and DI. The posteroanterior chest X-ray (<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>) revealed interstitial infiltration in the lower third of both lung fields, suggestive of edema.<elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia>The bedside echocardiogram in the emergency department showed left ventricular dilatation (60/44 mm) with diffuse hypocontractility, more marked in the apex, moderately impaired global systolic function (fractional shortening 26%), but no valvular abnormalities or pericardial effusion (<a class="elsevierStyleCrossRef" href="#fig0015">Figure 3</a>). A high-resolution thoracic computed tomography (CT) scan showed a low probability of pulmonary embolism. Serological tests for infectious agents commonly found in myocarditis and Chagas disease were negative.<elsevierMultimedia ident="fig0015"></elsevierMultimedia>Symptomatic treatment for HF was started with diuretics, angiotensin-converting enzyme (ACE) inhibitors and nitrates, but there was little symptomatic relief and the hypocalcemia was investigated further. Hypocalciuria and hyperphosphatemia were also detected due to reduced parathyroid hormone levels (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>). Investigation of the etiology of hypoparathyroidism ruled out cancer, infiltration, and polyglandular and autoimmune syndromes, and a diagnosis of idiopathic hypoparathyroidism was made. Renal ultrasound showed no alterations and a cranial CT scan (<a class="elsevierStyleCrossRef" href="#fig0020">Figure 4</a>) detected extensive supratentorial calcification, more evident in the basal ganglia, suggesting typical chronic hypoparathyroidism.<elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia>With a provisional diagnosis of HF of unknown etiology and hypocalcemia secondary to idiopathic hypoparathyroidism, the patient continued the above medication, to which were added intravenous calcium carbonate, a phosphate-binding agent (sevelamer) and vitamin D. Progressive normalization of calcium–phosphate metabolism was observed, accompanied by complete reversal of HF symptoms and normalization of ECG and echocardiographic findings (left ventricular size 50/32 mm, no wall motion abnormalities and fractional shortening 36%). Therapy for hypoparathyroidism was maintained but diuretics, nitrates and ACE inhibitors were discontinued. The patient remained asymptomatic.Cardiac catheterization revealed no significant coronary lesions and normal left ventricular function (ejection fraction 64%).The association between correction of hypocalcemia and disappearance of HF symptoms, in the absence of an alternative etiology for the latter, confirmed that hypoparathyroidism and resulting hypocalcemia were the cause of her HF.DiscussionRegulation of serum calcium levels depends mainly on parathyroid hormone, in the short term by calcium reabsorption by bone or kidneys (distal convoluted tubule), and by long-term adaptation, by stimulating renal production of vitamin D.<a class="elsevierStyleCrossRef" href="#bib0035">6</a>Calcium is essential to cardiac automatism and myocardial excitation–contraction coupling, and is thus vital for normal cardiac function. The entry of calcium into myocardial fibers induces release of calcium from the sarcoplasmic reticulum, raising the concentration of intracellular calcium, which binds to troponin C, a process which governs actin-myosin interaction and hence muscle contraction.<a class="elsevierStyleCrossRefs" href="#bib0060">7,8</a>The clinical manifestations of acute hypocalcemia are basically due to increased neuromuscular irritability, resulting in parasthesias and limb tremor, rhabdomyolysis, cramps and carpopedal spasm. Latent tetany is often revealed by Chvostek and Trousseau signs. Hypocalcemia can also have neuropsychiatric manifestations including irritability and depression,<a class="elsevierStyleCrossRefs" href="#bib0160">9,10</a> which may explain the psychomotor slowing and mental confusion in our patient, who also presented thinning of the outer third of the eyebrows, a typical sign of hypothyroidism, which she did not have. This sign may have been due to local autoimmune phenomena.In chronic forms of hypocalcemia, manifestations include cataracts, dental dysmorphisms and extrapyramidal symptoms due to calcification of basal ganglia.<a class="elsevierStyleCrossRefs" href="#bib0160">9,10</a>Severe hypocalcemia may be accompanied by various cardiovascular manifestations including long QT interval on the ECG, vasodilation with severe hypotension, and congestive HF, all of which are reversible following correction of the ionic imbalance.<a class="elsevierStyleCrossRefs" href="#bib0050">11,12</a> This imbalance can result in impairment of myocardial function and hence HF that is usually refractory to conventional treatment, although it is reversible with calcium replacement therapy,<a class="elsevierStyleCrossRef" href="#bib0045">10</a> as seen in our patient. It should also be noted that hypocalcemia reduces natriuresis, which may also contribute to HF.<a class="elsevierStyleCrossRefs" href="#bib0020">4,13</a>There are some descriptions in the literature of this rare and reversible cause of HF, which has been termed hypocalcemic cardiomyopathy.<a class="elsevierStyleCrossRefs" href="#bib0020">4,5,10,13–28</a> The first report was by Rose in 1943, who suggested “the possibility of some relationship between chronic parathyroid insufficiency and myocardial damage”.<a class="elsevierStyleCrossRef" href="#bib0030">29</a> Transient left ventricular dysfunction has also been documented following blood transfusions with citrate (a calcium-binding agent).<a class="elsevierStyleCrossRef" href="#bib0090">18</a> The common factor in these descriptions is HF in patients with severe hypocalcemia, partially or completely resolved following correction of the ionic imbalance. Various causes of hypocalcemia were reported, including iatrogenic<a class="elsevierStyleCrossRefs" href="#bib0020">4,24</a> and autoimmune<a class="elsevierStyleCrossRefs" href="#bib0110">13,25</a> hypoparathyroidism and rickets.<a class="elsevierStyleCrossRefs" href="#bib0090">18,20,28</a> In some cases coronary insufficiency was not formally excluded by angiography,<a class="elsevierStyleCrossRefs" href="#bib0020">4,22,25</a> but in most cases the association with HF was strong.In the case presented, the fact that the patient received combined therapy for HF and hypocalcemia makes it difficult to determine the precise effect of each treatment on the symptomatic improvement observed. However, in some cases in the literature there was no response to conventional therapy, but there was an unequivocal association between the introduction or discontinuation of calcium replacement therapy and improvement or worsening of HF, respectively.<a class="elsevierStyleCrossRefs" href="#bib0135">26,27</a>Although in this case, as in most others, there was normalization of ventricular systolic function, this is not always the case. There is no explanation for this in the literature, but it has been suggested that prolonged exposure of the myocardium to severe hypocalcemia may lead to structural damage, as seen in autopsies of cows that died from hypocalcemic cardiomyopathy, which detected widespread microscopic foci of myocardial necrosis.<a class="elsevierStyleCrossRefs" href="#bib0045">10,30</a> Myocardial biopsy in one patient revealed dilated sarcoplasmic reticulum and size variability in the mitochondria, which may have been secondary to metabolic abnormalities.<a class="elsevierStyleCrossRef" href="#bib0110">13</a>Another interesting point is the appearance of acute symptoms of hypocalcemia, including HF, in a patient with signs of chronic disease like calcification of basal ganglia. Decompensation frequently occurs in situations of increased calcium demand such as alkalosis, as seen in our patient, and can perpetuate and worsen hypocalcemia.<a class="elsevierStyleCrossRef" href="#bib0160">9</a> Rhabdomyolysis can be both cause and consequence of hypocalcemia, by altering membrane electrical activity, increasing the electrical excitability of muscle fibers and resulting in tremors, perpetuating the primary abnormality in a vicious cycle.<a class="elsevierStyleCrossRefs" href="#bib0030">29,31</a> The duration and severity of hypocalcemia are thus clearly important in triggering cardiac decompensation.<a class="elsevierStyleCrossRef" href="#bib0115">22</a>Ethical disclosuresProtection of human and animal subjectsThe authors declare that no experiments were performed on humans or animals for this study.Confidentiality of dataThe authors declare that they have followed the protocols of their work center on the publication of patient data and that all the patients included in the study received sufficient information and gave their written informed consent to participate in the study.Right to privacy and informed consentThe authors have obtained the written informed consent of the patients or subjects mentioned in the article. The corresponding author is in possession of this document.Conflicts of interestThe authors have no conflicts of interest to declare." "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:2 [ "identificador" => "xres251692" "titulo" => "Abstract" ] 1 => array:2 [ "identificador" => "xpalclavsec239291" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres251693" "titulo" => "Resumo" ] 3 => array:2 [ "identificador" => "xpalclavsec239290" "titulo" => "Palavras-chave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Case report" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion" ] 7 => array:3 [ "identificador" => "sec0020" "titulo" => "Ethical disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0025" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0030" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0035" "titulo" => "Right to privacy and informed consent" ] ] ] 8 => array:2 [ "identificador" => "sec0040" "titulo" => "Conflicts of interest" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2012-04-22" "fechaAceptado" => "2012-08-02" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec239291" "palabras" => array:4 [ 0 => "Cardiac failure" 1 => "Hypoparathyroidism" 2 => "Hypocalcemia" 3 => "Hypocalcemic cardiomyopathy" ] ] ] "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-chave" "identificador" => "xpalclavsec239290" "palabras" => array:4 [ 0 => "Insuficiência cardíaca" 1 => "Hipoparatiroidismo" 2 => "Hipocalcemia" 3 => "Miocardiopatia hipocalcémica" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "The association between hypocalcemia and heart failure is rare. There are few reported cases in the literature of this association, which is termed hypocalcemic cardiomyopathy.We report the case of a 61-year-old woman with no relevant medical history, admitted for progressively worsening exertional dyspnea, orthopnea and edema of the lower limbs over a period of one month. Physical examination showed diffuse muscle spasms, with no signs of latent tetany.Further investigation revealed ionized calcium 0.54 mmol/l (normal 1.12–1.30), phosphorus 9.8 mg/dl, parathyroid hormone <2.5 pg/ml and CK >3000 U/l, with normal thyroid function. The electrocardiogram showed long QT interval and a pattern of left ventricular overload, and myocardial biomarkers were negative. The echocardiogram revealed regional wall motion abnormalities, coronary angiography was normal and a cranial CT scan detected calcification of basal ganglia and white matter.She started diuretic and calcium replacement therapy which resulted in complete clinical recovery, with no need for heart failure therapy after normalization of serum calcium." ] "pt" => array:2 [ "titulo" => "Resumo" "resumen" => "A associação entre hipocalcemia e insuficiência cardíaca é rara. Na literatura existem poucos casos descritos com esta associação, tendo-se estabelecido a entidade miocardiopatia hipocalcemica.Relata-se o caso de uma mulher, 61 anos, sem antecedentes médicos relevantes. Internada por um quadro com um mês de evolução de dispneia de esforço, ortopneia e edema dos membros inferiores de agravamento progressivo. À observação apresentava espasmos musculares difusos, sem sinais de tetania latente.Da investigação complementar destacavam-se cálcio ionizado 0,54 mmol/l (1,12-1,30), fósforo 9,8 mg/dl, hormona paratiroideia <2,5 pg/ml e CK total >3000 U/l, com função tiroideia normal. O electrocardiograma revelava prolongamento do intervalo QT e padrão de sobrecarga do ventrículo esquerdo e os marcadores de necrose miocárdica eram negativos. O ecocardiograma demonstrava alterações segmentares da contractilidade miocárdica, a coronariografia era normal e na TC-CE identificavam-se calcificações dos núcleos basais e substância branca.Iniciou terapêutica diurética e de reposição do cálcio com remissão completa da insuficiência cardíaca, sem necessidade de terapêutica específica para a mesma após normalização da calcemia." ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Aguiar P, et al. Miocardiopatia hipocalcémica. Rev Port Cardiol. 2013. doi:10.1016/j.repc.2012.08.008." ] ] "multimedia" => array:7 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1129 "Ancho" => 1667 "Tamanyo" => 222679 ] ] "descripcion" => array:1 [ "en" => "Electrocardiogram." ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1709 "Ancho" => 1667 "Tamanyo" => 154378 ] ] "descripcion" => array:1 [ "en" => "Chest X-ray." ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1483 "Ancho" => 1667 "Tamanyo" => 99909 ] ] "descripcion" => array:1 [ "en" => "Echocardiogram." ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1779 "Ancho" => 1667 "Tamanyo" => 145280 ] ] "descripcion" => array:1 [ "en" => "Cranial computed tomography scan." ] ] 4 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Congenital \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Glycogenoses \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mucopolysaccharidoses \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Fabry disease \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hemochromatosis \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Danon disease \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Friedreich ataxia \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Acquired \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hypothyroidism \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hyperthyroidism \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hypocalcemia \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Alcohol/drug toxicity \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Diabetes \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pheochromocytoma \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Acromegaly \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Beriberi \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab355019.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Metabolic etiologies of reversible cardiomyopathy." ] ] 5 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "TSH: thyroid-stimulating hormone." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">LDH cholesterol (U/l) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">989 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CK (U/l) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3784 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NT-proBNP (pg/ml) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3994 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">TSH (U/ml) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.32 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Troponin (ng/ml) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><0.04 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">pH \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7.46 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">PO2 (mmHg) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">67 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">PCO2 (mmHg) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">29 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ca2+ (mmol/l) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.54 (1.13–1.32) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab355020.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Initial laboratory assessment." ] ] 6 => array:7 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "PTH: parathyroid hormone." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Calciuria (mg/day) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">89.9 (100–320) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Phosphorus (mg/dl) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9.8 (2.4–5.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Magnesium (mg/dl) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.9 (1.3–2.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">PTH (pg/ml) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><2.5 (14–72) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Anti-parathyroid antibodies \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab355018.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Diagnostic investigation of hypocalcemia." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:31 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Heart failure and cor pulmonale" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:1 [ 0 => "D. Mann" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:4 [ "titulo" => "Harrison – principles of internal medicine" "paginaInicial" => "1443" "paginaFinal" => "1455" "serieFecha" => "2008" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diagnostic and treatment of heart failure" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:2 [ 0 => "L. Demopoulos" 1 => "E. Sonnenblick" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:4 [ "titulo" => "Hurst's – the heart" "paginaInicial" => "1" "paginaFinal" => "16" "serieFecha" => "1999" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cardiomyopathy and myocarditis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:2 [ 0 => "J. Wynne" 1 => "E. Braunwald" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:4 [ "titulo" => "Harrison – principles of internal medicine" "paginaInicial" => "1481" "paginaFinal" => "1488" "serieFecha" => "2008" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Dilated cardiomyopathy and hypoparathyroidism: complete recovery after hypocalcemia correction" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "D.A. Avramides" 1 => "S.S. Ionitse" 2 => "F.K. Panou" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Hellenic J Cardiol" "fecha" => "2003" "volumen" => "44" "paginaInicial" => "150" "paginaFinal" => "154" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Miocardiopatia dilatada por dupla disfunção endócrina" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "D. Brito" 1 => "M. Pedro" 2 => "A. Bordalo" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Rev Port Cardiol" "fecha" => "2003" "volumen" => "22" "paginaInicial" => "377" "paginaFinal" => "387" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12847879" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0035" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hypercalcemia and hypocalcemia" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:1 [ 0 => "S. Khosla" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:4 [ "titulo" => "Harrison – principles of internal medicine" "paginaInicial" => "285" "paginaFinal" => "287" "serieFecha" => "2008" ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0060" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Basic biology of cardiovascular system" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:2 [ 0 => "P. Libby" 1 => "E. Braunwald" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:4 [ "titulo" => "Harrison – principles of internal medicine" "paginaInicial" => "1365" "paginaFinal" => "1375" "serieFecha" => "2008" ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0065" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cardiac excitation-contraction coupling" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "D.M. Bers" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1038/415198a" "Revista" => array:6 [ "tituloSerie" => "Nature" "fecha" => "2002" "volumen" => "415" "paginaInicial" => "198" "paginaFinal" => "205" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11805843" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0160" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hypoparathyroidism" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:2 [ 0 => "D. Goltzman" 1 => "D. Cole" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:4 [ "titulo" => "Primer on the metabolic bone diseases and disorders of mineral metabolism" "paginaInicial" => "220" "paginaFinal" => "223" "serieFecha" => "1996" ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0045" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Miocardiopatía hipocalcémica secundaria a hipoparatiroidismo postiroidectomia: caso clinico" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "J. Lam" 1 => "P. Marageno" 2 => "B. Lépez" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "/S0034-98872007000300011" "Revista" => array:6 [ "tituloSerie" => "Rev Méd Chile" "fecha" => "2007" "volumen" => "135" "paginaInicial" => "359" "paginaFinal" => "364" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17505582" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0050" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hypocalcemic emergencies" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "P.M. Reber" 1 => "H. Heath 3rd" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Med Clin North Am" "fecha" => "1995" "volumen" => "79" "paginaInicial" => "93" "paginaFinal" => "106" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7808098" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0055" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hypocalcemic crisis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "G.P. Zaloga" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Crit Care Clin" "fecha" => "1991" "volumen" => "7" "paginaInicial" => "191" "paginaFinal" => "200" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2007214" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0110" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A case of primary hypoparathyroidism complicated by heart failure" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "T. Mano" 1 => "H. Kaniya" 2 => "S. Kawakit" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Jpn J Med" "fecha" => "1991" "volumen" => "30" "paginaInicial" => "464" "paginaFinal" => "467" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1803049" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0070" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hypocalcemic heart failure: a reversible form of heart muscle disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "T. Suzuki" 1 => "U. Ikada" 2 => "H. Fujikawa" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Clin Cardiol" "fecha" => "1998" "volumen" => "21" "paginaInicial" => "227" "paginaFinal" => "228" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9541771" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0075" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hypocalcemic cardiomyopathy as the cause of severe left heart failure" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "H. Mönig" 1 => "K.P. Föh" 2 => "H.M. Schulte" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1055/s-2008-1058832" "Revista" => array:6 [ "tituloSerie" => "Dtsch Med Wochenschr" "fecha" => "1994" "volumen" => "119" "paginaInicial" => "1270" "paginaFinal" => "1275" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7924918" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0080" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cardiac failure secondary to hypoparathyroidism. An unusual presentation" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "A. Greca" 1 => "N. Hernández" 2 => "R. Ríos" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Medicina (B Aires)" "fecha" => "1997" "volumen" => "57" "paginaInicial" => "320" "paginaFinal" => "322" ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0085" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hypocalcemic cardiomyopathy due to untreated hypoparathyroidism" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "H. Altunbaş" 1 => "M.K. Balci" 2 => "G. Yazicioglu" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "69324" "Revista" => array:6 [ "tituloSerie" => "Horm Res" "fecha" => "2003" "volumen" => "59" "paginaInicial" => "201" "paginaFinal" => "204" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12649575" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0090" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hypocalcemic heart failure masquerading as dilated cardiomyopathy" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "S. Gulati" 1 => "A. Bajpai" 2 => "R. Juneja" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Indian J Pediatr" "fecha" => "2001" "volumen" => "68" "paginaInicial" => "287" "paginaFinal" => "290" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11338230" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0095" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Severe hypocalcemia: a rare cause of reversible heart failure" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "N. Mikhail" 1 => "A. El-Bialy" 2 => "J. Grosser" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Congest Heart Fail" "fecha" => "2001" "volumen" => "7" "paginaInicial" => "256" "paginaFinal" => "258" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11832664" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0100" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hypocalcemic rickets and dilated cardiomyopathy: case reports and review of literature" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "J. Brown" 1 => "S. Nunez" 2 => "M. Russell" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00246-009-9444-z" "Revista" => array:6 [ "tituloSerie" => "Pediatr Cardiol" "fecha" => "2009" "volumen" => "30" "paginaInicial" => "818" "paginaFinal" => "823" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19387720" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0105" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hypocalcemic cardiac failure in the emergency department" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "K. Hurley" 1 => "D. Baggs" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jemermed.2004.06.014" "Revista" => array:6 [ "tituloSerie" => "J Emerg Med" "fecha" => "2005" "volumen" => "28" "paginaInicial" => "155" "paginaFinal" => "159" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15707810" "web" => "Medline" ] ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0115" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hypocalcemic cardiomyopathy" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "T. Bashour" 1 => "H.S. Basha" 2 => "T.O. Cheng" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Chest" "fecha" => "1980" "volumen" => "78" "paginaInicial" => "663" "paginaFinal" => "665" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/6448134" "web" => "Medline" ] ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0120" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A rare cause of heart failure – primary hypoparathyroidism" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "R.P. Gupta" 1 => "R.A. Krishnan" 2 => "S. Kumar" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Assoc Physicians India" "fecha" => "2007" "volumen" => "55" "paginaInicial" => "522" "paginaFinal" => "524" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17907506" "web" => "Medline" ] ] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0125" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A rare cause of reversible dilated cardiomyopathy: hypocalcemia" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "A. Avsar" 1 => "A. Dogan" 2 => "T. Tavli" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.0742-2822.2004.03149.x" "Revista" => array:6 [ "tituloSerie" => "Echocardiography" "fecha" => "2004" "volumen" => "21" "paginaInicial" => "609" "paginaFinal" => "612" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15488088" "web" => "Medline" ] ] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0130" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Idiopathic hypoparathyroidism presenting as congestive heart failure" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "P. Linares Torres" 1 => "R. García Díez" 2 => "C. Castanón López" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Rev Esp Cardiol" "fecha" => "2001" "volumen" => "54" "paginaInicial" => "1347" "paginaFinal" => "1348" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11707251" "web" => "Medline" ] ] ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0135" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hypocalcemia precipitating congestive heart failure" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "T.B. Connor" 1 => "B.L. Rosen" 2 => "M.P. Blaustein" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJM198209303071407" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "1982" "volumen" => "307" "paginaInicial" => "869" "paginaFinal" => "872" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7110262" "web" => "Medline" ] ] ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0140" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hypocalcemia-induced hemodynamic dysfunction" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "A. Gurtoo" 1 => "R. Goswami" 2 => "B. Singh" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Int J Cardiol" "fecha" => "1994" "volumen" => "43" "paginaInicial" => "91" "paginaFinal" => "93" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8175224" "web" => "Medline" ] ] ] ] ] ] ] ] 27 => array:3 [ "identificador" => "bib0145" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hypocalcemic rickets: an unusual cause of dilated cardiomyopathy" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "D.I. Price" 1 => "L.C. Stanford" 2 => "D.S. Braden" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00246-002-0251-z" "Revista" => array:6 [ "tituloSerie" => "Pediatr Cardiol" "fecha" => "2003" "volumen" => "24" "paginaInicial" => "510" "paginaFinal" => "512" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14627327" "web" => "Medline" ] ] ] ] ] ] ] ] 28 => array:3 [ "identificador" => "bib0030" "etiqueta" => "29" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hypoparathyroidism" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "E. Rose" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Clinics" "fecha" => "1943" "volumen" => "1" "paginaInicial" => "1179" "paginaFinal" => "1196" ] ] ] ] ] ] 29 => array:3 [ "identificador" => "bib0150" "etiqueta" => "30" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Calcium metabolism in hypocalcemic cows with myocardial lesion" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "N. Yamagishi" 1 => "Y. Naito" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Vet Med Sci" "fecha" => "1997" "volumen" => "59" "paginaInicial" => "71" "paginaFinal" => "73" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9035084" "web" => "Medline" ] ] ] ] ] ] ] ] 30 => array:3 [ "identificador" => "bib0155" "etiqueta" => "31" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Rhabdomyolysis in a patient with hypocalcemia due to hypoparathyroidism" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "M. Akmal" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Am J Nephrol" "fecha" => "1993" "volumen" => "13" "paginaInicial" => "61" "paginaFinal" => "63" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8322842" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21742049/0000003200000004/v1_201308021404/S2174204913000597/v1_201308021404/en/main.assets" "Apartado" => array:4 [ "identificador" => "9919" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Case Reports" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21742049/0000003200000004/v1_201308021404/S2174204913000597/v1_201308021404/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204913000597?idApp=UINPBA00004E"]

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Case report

Hypocalcemic cardiomyopathy

Miocardiopatia hipocalcémica

Patrício Aguiara,

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patricio_aguiar@yahoo.com.br

Corresponding author.

, Diogo Cruza, Rita Ferro Rodriguesb, Lígia Peixotoa, Francisco Araújoc, José Luís Ducla Soaresa

a Serviço de Medicina 1, Centro Hospitalar Lisboa Norte, EPE, Lisboa, Portugal

b Serviço de Doenças Infecciosas, Centro Hospitalar Lisboa Norte, EPE, Lisboa, Portugal

c Departamento de Medicina Interna, Hospital Beatriz Ângelo, Loures, Portugal

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revealed interstitial infiltration in the lower third of both lung fields&#44; suggestive of edema&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">The bedside echocardiogram in the emergency department showed left ventricular dilatation &#40;60&#47;44 mm&#41; with diffuse hypocontractility&#44; more marked in the apex&#44; moderately impaired global systolic function &#40;fractional shortening 26&#37;&#41;&#44; but no valvular abnormalities or pericardial effusion &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Figure 3</a>&#41;&#46; A high-resolution thoracic computed tomography &#40;CT&#41; scan showed a low probability of pulmonary embolism&#46; Serological tests for infectious agents commonly found in myocarditis and Chagas disease were negative&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">Symptomatic treatment for HF was started with diuretics&#44; angiotensin-converting enzyme &#40;ACE&#41; inhibitors and nitrates&#44; but there was little symptomatic relief and the hypocalcemia was investigated further&#46; Hypocalciuria and hyperphosphatemia were also detected due to reduced parathyroid hormone levels &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46; Investigation of the etiology of hypoparathyroidism ruled out cancer&#44; infiltration&#44; and polyglandular and autoimmune syndromes&#44; and a diagnosis of idiopathic hypoparathyroidism was made&#46; Renal ultrasound showed no alterations and a cranial CT scan &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Figure 4</a>&#41; detected extensive supratentorial calcification&#44; more evident in the basal ganglia&#44; suggesting typical chronic hypoparathyroidism&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">With a provisional diagnosis of HF of unknown etiology and hypocalcemia secondary to idiopathic hypoparathyroidism&#44; the patient continued the above medication&#44; to which were added intravenous calcium carbonate&#44; a phosphate-binding agent &#40;sevelamer&#41; and vitamin D&#46; Progressive normalization of calcium&#8211;phosphate metabolism was observed&#44; accompanied by complete reversal of HF symptoms and normalization of ECG and echocardiographic findings &#40;left ventricular size 50&#47;32 mm&#44; no wall motion abnormalities and fractional shortening 36&#37;&#41;&#46; Therapy for hypoparathyroidism was maintained but diuretics&#44; nitrates and ACE inhibitors were discontinued&#46; The patient remained asymptomatic&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Cardiac catheterization revealed no significant coronary lesions and normal left ventricular function &#40;ejection fraction 64&#37;&#41;&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">The association between correction of hypocalcemia and disappearance of HF symptoms&#44; in the absence of an alternative etiology for the latter&#44; confirmed that hypoparathyroidism and resulting hypocalcemia were the cause of her HF&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discussion</span><p id="par0070" class="elsevierStylePara elsevierViewall">Regulation of serum calcium levels depends mainly on parathyroid hormone&#44; in the short term by calcium reabsorption by bone or kidneys &#40;distal convoluted tubule&#41;&#44; and by long-term adaptation&#44; by stimulating renal production of vitamin D&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">6</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">Calcium is essential to cardiac automatism and myocardial excitation&#8211;contraction coupling&#44; and is thus vital for normal cardiac function&#46; The entry of calcium into myocardial fibers induces release of calcium from the sarcoplasmic reticulum&#44; raising the concentration of intracellular calcium&#44; which binds to troponin C&#44; a process which governs actin-myosin interaction and hence muscle contraction&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">7&#44;8</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">The clinical manifestations of acute hypocalcemia are basically due to increased neuromuscular irritability&#44; resulting in parasthesias and limb tremor&#44; rhabdomyolysis&#44; cramps and carpopedal spasm&#46; Latent tetany is often revealed by Chvostek and Trousseau signs&#46; Hypocalcemia can also have neuropsychiatric manifestations including irritability and depression&#44;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">9&#44;10</span></a> which may explain the psychomotor slowing and mental confusion in our patient&#44; who also presented thinning of the outer third of the eyebrows&#44; a typical sign of hypothyroidism&#44; which she did not have&#46; This sign may have been due to local autoimmune phenomena&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">In chronic forms of hypocalcemia&#44; manifestations include cataracts&#44; dental dysmorphisms and extrapyramidal symptoms due to calcification of basal ganglia&#46;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">9&#44;10</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">Severe hypocalcemia may be accompanied by various cardiovascular manifestations including long QT interval on the ECG&#44; vasodilation with severe hypotension&#44; and congestive HF&#44; all of which are reversible following correction of the ionic imbalance&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">11&#44;12</span></a> This imbalance can result in impairment of myocardial function and hence HF that is usually refractory to conventional treatment&#44; although it is reversible with calcium replacement therapy&#44;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">10</span></a> as seen in our patient&#46; It should also be noted that hypocalcemia reduces natriuresis&#44; which may also contribute to HF&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;13</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">There are some descriptions in the literature of this rare and reversible cause of HF&#44; which has been termed hypocalcemic cardiomyopathy&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;5&#44;10&#44;13&#8211;28</span></a> The first report was by Rose in 1943&#44; who suggested &#8220;the possibility of some relationship between chronic parathyroid insufficiency and myocardial damage&#8221;&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">29</span></a> Transient left ventricular dysfunction has also been documented following blood transfusions with citrate &#40;a calcium-binding agent&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> The common factor in these descriptions is HF in patients with severe hypocalcemia&#44; partially or completely resolved following correction of the ionic imbalance&#46; Various causes of hypocalcemia were reported&#44; including iatrogenic<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;24</span></a> and autoimmune<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">13&#44;25</span></a> hypoparathyroidism and rickets&#46;<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">18&#44;20&#44;28</span></a> In some cases coronary insufficiency was not formally excluded by angiography&#44;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;22&#44;25</span></a> but in most cases the association with HF was strong&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">In the case presented&#44; the fact that the patient received combined therapy for HF and hypocalcemia makes it difficult to determine the precise effect of each treatment on the symptomatic improvement observed&#46; However&#44; in some cases in the literature there was no response to conventional therapy&#44; but there was an unequivocal association between the introduction or discontinuation of calcium replacement therapy and improvement or worsening of HF&#44; respectively&#46;<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">26&#44;27</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">Although in this case&#44; as in most others&#44; there was normalization of ventricular systolic function&#44; this is not always the case&#46; There is no explanation for this in the literature&#44; but it has been suggested that prolonged exposure of the myocardium to severe hypocalcemia may lead to structural damage&#44; as seen in autopsies of cows that died from hypocalcemic cardiomyopathy&#44; which detected widespread microscopic foci of myocardial necrosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">10&#44;30</span></a> Myocardial biopsy in one patient revealed dilated sarcoplasmic reticulum and size variability in the mitochondria&#44; which may have been secondary to metabolic abnormalities&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">13</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">Another interesting point is the appearance of acute symptoms of hypocalcemia&#44; including HF&#44; in a patient with signs of chronic disease like calcification of basal ganglia&#46; Decompensation frequently occurs in situations of increased calcium demand such as alkalosis&#44; as seen in our patient&#44; and can perpetuate and worsen hypocalcemia&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">9</span></a> Rhabdomyolysis can be both cause and consequence of hypocalcemia&#44; by altering membrane electrical activity&#44; increasing the electrical excitability of muscle fibers and resulting in tremors&#44; perpetuating the primary abnormality in a vicious cycle&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">29&#44;31</span></a> The duration and severity of hypocalcemia are thus clearly important in triggering cardiac decompensation&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">22</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Ethical disclosures</span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Protection of human and animal subjects</span><p id="par0115" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Confidentiality of data</span><p id="par0120" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work center on the publication of patient data and that all the patients included in the study received sufficient information and gave their written informed consent to participate in the study&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Right to privacy and informed consent</span><p id="par0125" class="elsevierStylePara elsevierViewall">The authors have obtained the written informed consent of the patients or subjects mentioned in the article&#46; The corresponding author is in possession of this document&#46;</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflicts of interest</span><p id="par0130" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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          "identificador" => "xres251692"
          "titulo" => "Abstract"
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          "identificador" => "xpalclavsec239291"
          "titulo" => "Keywords"
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          "identificador" => "xres251693"
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          "titulo" => "Palavras-chave"
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          "titulo" => "Introduction"
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          "titulo" => "Ethical disclosures"
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              "identificador" => "sec0025"
              "titulo" => "Protection of human and animal subjects"
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            1 => array:2 [
              "identificador" => "sec0030"
              "titulo" => "Confidentiality of data"
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            2 => array:2 [
              "identificador" => "sec0035"
              "titulo" => "Right to privacy and informed consent"
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    "fechaRecibido" => "2012-04-22"
    "fechaAceptado" => "2012-08-02"
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        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec239291"
          "palabras" => array:4 [
            0 => "Cardiac failure"
            1 => "Hypoparathyroidism"
            2 => "Hypocalcemia"
            3 => "Hypocalcemic cardiomyopathy"
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      "pt" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palavras-chave"
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          "palabras" => array:4 [
            0 => "Insufici&#234;ncia card&#237;aca"
            1 => "Hipoparatiroidismo"
            2 => "Hipocalcemia"
            3 => "Miocardiopatia hipocalc&#233;mica"
          ]
        ]
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    "resumen" => array:2 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The association between hypocalcemia and heart failure is rare&#46; There are few reported cases in the literature of this association&#44; which is termed hypocalcemic cardiomyopathy&#46;</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">We report the case of a 61-year-old woman with no relevant medical history&#44; admitted for progressively worsening exertional dyspnea&#44; orthopnea and edema of the lower limbs over a period of one month&#46; Physical examination showed diffuse muscle spasms&#44; with no signs of latent tetany&#46;</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Further investigation revealed ionized calcium 0&#46;54 mmol&#47;l &#40;normal 1&#46;12&#8211;1&#46;30&#41;&#44; phosphorus 9&#46;8 mg&#47;dl&#44; parathyroid hormone &#60;2&#46;5 pg&#47;ml and CK &#62;3000 U&#47;l&#44; with normal thyroid function&#46; The electrocardiogram showed long QT interval and a pattern of left ventricular overload&#44; and myocardial biomarkers were negative&#46; The echocardiogram revealed regional wall motion abnormalities&#44; coronary angiography was normal and a cranial CT scan detected calcification of basal ganglia and white matter&#46;</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">She started diuretic and calcium replacement therapy which resulted in complete clinical recovery&#44; with no need for heart failure therapy after normalization of serum calcium&#46;</p>"
      ]
      "pt" => array:2 [
        "titulo" => "Resumo"
        "resumen" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">A associa&#231;&#227;o entre hipocalcemia e insufici&#234;ncia card&#237;aca &#233; rara&#46; Na literatura existem poucos casos descritos com esta associa&#231;&#227;o&#44; tendo-se estabelecido a entidade miocardiopatia hipocalcemica&#46;</p><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Relata-se o caso de uma mulher&#44; 61 anos&#44; sem antecedentes m&#233;dicos relevantes&#46; Internada por um quadro com um m&#234;s de evolu&#231;&#227;o de dispneia de esfor&#231;o&#44; ortopneia e edema dos membros inferiores de agravamento progressivo&#46; &#192; observa&#231;&#227;o apresentava espasmos musculares difusos&#44; sem sinais de tetania latente&#46;</p><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Da investiga&#231;&#227;o complementar destacavam-se c&#225;lcio ionizado 0&#44;54 mmol&#47;l &#40;1&#44;12-1&#44;30&#41;&#44; f&#243;sforo 9&#44;8 mg&#47;dl&#44; hormona paratiroideia &#60;2&#44;5 pg&#47;ml e CK total &#62;3000 U&#47;l&#44; com fun&#231;&#227;o tiroideia normal&#46; O electrocardiograma revelava prolongamento do intervalo QT e padr&#227;o de sobrecarga do ventr&#237;culo esquerdo e os marcadores de necrose mioc&#225;rdica eram negativos&#46; O ecocardiograma demonstrava altera&#231;&#245;es segmentares da contractilidade mioc&#225;rdica&#44; a coronariografia era normal e na TC-CE identificavam-se calcifica&#231;&#245;es dos n&#250;cleos basais e subst&#226;ncia branca&#46;</p><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Iniciou terap&#234;utica diur&#233;tica e de reposi&#231;&#227;o do c&#225;lcio com remiss&#227;o completa da insufici&#234;ncia card&#237;aca&#44; sem necessidade de terap&#234;utica espec&#237;fica para a mesma ap&#243;s normaliza&#231;&#227;o da calcemia&#46;</p>"
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        "nota" => "<p class="elsevierStyleNotepara">Please cite this article as&#58; Aguiar P&#44; et al&#46; Miocardiopatia hipocalc&#233;mica&#46; Rev Port Cardiol&#46; 2013&#46; <span class="elsevierStyleInterRef" href="doi:10.1016/j.repc.2012.08.008">doi&#58;10&#46;1016&#47;j&#46;repc&#46;2012&#46;08&#46;008</span>&#46;</p>"
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                  \t\t\t\t"><span class="elsevierStyleItalic">Congenital</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mucopolysaccharidoses&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Fabry disease&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hemochromatosis&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Danon disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Friedreich ataxia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Acquired</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hypothyroidism&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hyperthyroidism&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hypocalcemia&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Alcohol&#47;drug toxicity&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Diabetes&nbsp;\t\t\t\t\t\t\n
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                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Med Clin North Am"
                        "fecha" => "1995"
                        "volumen" => "79"
                        "paginaInicial" => "93"
                        "paginaFinal" => "106"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7808098"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Hypocalcemic crisis"
                      "autores" => array:1 [
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                          "etal" => false
                          "autores" => array:1 [
                            0 => "G&#46;P&#46; Zaloga"
                          ]
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                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Crit Care Clin"
                        "fecha" => "1991"
                        "volumen" => "7"
                        "paginaInicial" => "191"
                        "paginaFinal" => "200"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2007214"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0110"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A case of primary hypoparathyroidism complicated by heart failure"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "T&#46; Mano"
                            1 => "H&#46; Kaniya"
                            2 => "S&#46; Kawakit"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Jpn J Med"
                        "fecha" => "1991"
                        "volumen" => "30"
                        "paginaInicial" => "464"
                        "paginaFinal" => "467"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1803049"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Hypocalcemic heart failure&#58; a reversible form of heart muscle disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "T&#46; Suzuki"
                            1 => "U&#46; Ikada"
                            2 => "H&#46; Fujikawa"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Cardiol"
                        "fecha" => "1998"
                        "volumen" => "21"
                        "paginaInicial" => "227"
                        "paginaFinal" => "228"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9541771"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Hypocalcemic cardiomyopathy as the cause of severe left heart failure"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "H&#46; M&#246;nig"
                            1 => "K&#46;P&#46; F&#246;h"
                            2 => "H&#46;M&#46; Schulte"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1055/s-2008-1058832"
                      "Revista" => array:6 [
                        "tituloSerie" => "Dtsch Med Wochenschr"
                        "fecha" => "1994"
                        "volumen" => "119"
                        "paginaInicial" => "1270"
                        "paginaFinal" => "1275"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7924918"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cardiac failure secondary to hypoparathyroidism&#46; An unusual presentation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "A&#46; Greca"
                            1 => "N&#46; Hern&#225;ndez"
                            2 => "R&#46; R&#237;os"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Medicina &#40;B Aires&#41;"
                        "fecha" => "1997"
                        "volumen" => "57"
                        "paginaInicial" => "320"
                        "paginaFinal" => "322"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Hypocalcemic cardiomyopathy due to untreated hypoparathyroidism"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "H&#46; Altunba&#351;"
                            1 => "M&#46;K&#46; Balci"
                            2 => "G&#46; Yazicioglu"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "69324"
                      "Revista" => array:6 [
                        "tituloSerie" => "Horm Res"
                        "fecha" => "2003"
                        "volumen" => "59"
                        "paginaInicial" => "201"
                        "paginaFinal" => "204"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12649575"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Hypocalcemic heart failure masquerading as dilated cardiomyopathy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "S&#46; Gulati"
                            1 => "A&#46; Bajpai"
                            2 => "R&#46; Juneja"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Indian J Pediatr"
                        "fecha" => "2001"
                        "volumen" => "68"
                        "paginaInicial" => "287"
                        "paginaFinal" => "290"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11338230"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Severe hypocalcemia&#58; a rare cause of reversible heart failure"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "N&#46; Mikhail"
                            1 => "A&#46; El-Bialy"
                            2 => "J&#46; Grosser"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Congest Heart Fail"
                        "fecha" => "2001"
                        "volumen" => "7"
                        "paginaInicial" => "256"
                        "paginaFinal" => "258"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11832664"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Hypocalcemic rickets and dilated cardiomyopathy&#58; case reports and review of literature"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "J&#46; Brown"
                            1 => "S&#46; Nunez"
                            2 => "M&#46; Russell"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00246-009-9444-z"
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatr Cardiol"
                        "fecha" => "2009"
                        "volumen" => "30"
                        "paginaInicial" => "818"
                        "paginaFinal" => "823"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19387720"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0105"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Hypocalcemic cardiac failure in the emergency department"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "K&#46; Hurley"
                            1 => "D&#46; Baggs"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jemermed.2004.06.014"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Emerg Med"
                        "fecha" => "2005"
                        "volumen" => "28"
                        "paginaInicial" => "155"
                        "paginaFinal" => "159"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15707810"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0115"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Hypocalcemic cardiomyopathy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "T&#46; Bashour"
                            1 => "H&#46;S&#46; Basha"
                            2 => "T&#46;O&#46; Cheng"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest"
                        "fecha" => "1980"
                        "volumen" => "78"
                        "paginaInicial" => "663"
                        "paginaFinal" => "665"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/6448134"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0120"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A rare cause of heart failure &#8211; primary hypoparathyroidism"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "R&#46;P&#46; Gupta"
                            1 => "R&#46;A&#46; Krishnan"
                            2 => "S&#46; Kumar"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Assoc Physicians India"
                        "fecha" => "2007"
                        "volumen" => "55"
                        "paginaInicial" => "522"
                        "paginaFinal" => "524"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17907506"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0125"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A rare cause of reversible dilated cardiomyopathy&#58; hypocalcemia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "A&#46; Avsar"
                            1 => "A&#46; Dogan"
                            2 => "T&#46; Tavli"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.0742-2822.2004.03149.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Echocardiography"
                        "fecha" => "2004"
                        "volumen" => "21"
                        "paginaInicial" => "609"
                        "paginaFinal" => "612"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15488088"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0130"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Idiopathic hypoparathyroidism presenting as congestive heart failure"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "P&#46; Linares Torres"
                            1 => "R&#46; Garc&#237;a D&#237;ez"
                            2 => "C&#46; Castan&#243;n L&#243;pez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Esp Cardiol"
                        "fecha" => "2001"
                        "volumen" => "54"
                        "paginaInicial" => "1347"
                        "paginaFinal" => "1348"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11707251"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib0135"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Hypocalcemia precipitating congestive heart failure"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "T&#46;B&#46; Connor"
                            1 => "B&#46;L&#46; Rosen"
                            2 => "M&#46;P&#46; Blaustein"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJM198209303071407"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "1982"
                        "volumen" => "307"
                        "paginaInicial" => "869"
                        "paginaFinal" => "872"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7110262"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib0140"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Hypocalcemia-induced hemodynamic dysfunction"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "A&#46; Gurtoo"
                            1 => "R&#46; Goswami"
                            2 => "B&#46; Singh"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Cardiol"
                        "fecha" => "1994"
                        "volumen" => "43"
                        "paginaInicial" => "91"
                        "paginaFinal" => "93"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8175224"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0145"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Hypocalcemic rickets&#58; an unusual cause of dilated cardiomyopathy"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "D&#46;I&#46; Price"
                            1 => "L&#46;C&#46; Stanford"
                            2 => "D&#46;S&#46; Braden"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00246-002-0251-z"
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatr Cardiol"
                        "fecha" => "2003"
                        "volumen" => "24"
                        "paginaInicial" => "510"
                        "paginaFinal" => "512"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14627327"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Hypoparathyroidism"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "E&#46; Rose"
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                      "Revista" => array:5 [
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                        "volumen" => "1"
                        "paginaInicial" => "1179"
                        "paginaFinal" => "1196"
                      ]
                    ]
                  ]
                ]
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              "identificador" => "bib0150"
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Calcium metabolism in hypocalcemic cows with myocardial lesion"
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                          "etal" => false
                          "autores" => array:2 [
                            0 => "N&#46; Yamagishi"
                            1 => "Y&#46; Naito"
                          ]
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                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Vet Med Sci"
                        "fecha" => "1997"
                        "volumen" => "59"
                        "paginaInicial" => "71"
                        "paginaFinal" => "73"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9035084"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
                  ]
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bib0155"
              "etiqueta" => "31"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Rhabdomyolysis in a patient with hypocalcemia due to hypoparathyroidism"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "M&#46; Akmal"
                          ]
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                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Nephrol"
                        "fecha" => "1993"
                        "volumen" => "13"
                        "paginaInicial" => "61"
                        "paginaFinal" => "63"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8322842"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
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]

Article information

ISSN: 21742049
Original language: English

DOI:10.1016/j.repce.2012.08.007

The statistics are updated each day

Year/Month	Html	Pdf	Total

2024 November	8	5	13
2024 October	53	23	76
2024 September	83	24	107
2024 August	67	28	95
2024 July	75	31	106
2024 June	80	22	102
2024 May	71	24	95
2024 April	51	19	70
2024 March	68	19	87
2024 February	61	20	81
2024 January	60	27	87
2023 December	49	34	83
2023 November	64	24	88
2023 October	63	15	78
2023 September	63	25	88
2023 August	74	21	95
2023 July	70	12	82
2023 June	49	20	69
2023 May	95	23	118
2023 April	66	7	73
2023 March	118	14	132
2023 February	76	21	97
2023 January	64	20	84
2022 December	66	24	90
2022 November	88	39	127
2022 October	53	18	71
2022 September	67	67	134
2022 August	57	34	91
2022 July	63	32	95
2022 June	51	25	76
2022 May	54	38	92
2022 April	49	26	75
2022 March	49	34	83
2022 February	61	21	82
2022 January	66	23	89
2021 December	36	27	63
2021 November	50	40	90
2021 October	61	42	103
2021 September	54	25	79
2021 August	47	35	82
2021 July	44	32	76
2021 June	59	27	86
2021 May	87	48	135
2021 April	135	50	185
2021 March	87	20	107
2021 February	89	21	110
2021 January	46	20	66
2020 December	39	8	47
2020 November	47	15	62
2020 October	23	20	43
2020 September	60	12	72
2020 August	35	9	44
2020 July	59	8	67
2020 June	44	10	54
2020 May	51	12	63
2020 April	61	7	68
2020 March	47	4	51
2020 February	111	33	144
2020 January	54	8	62
2019 December	151	18	169
2019 November	50	11	61
2019 October	64	2	66
2019 September	52	10	62
2019 August	38	5	43
2019 July	55	14	69
2019 June	29	7	36
2019 May	48	5	53
2019 April	42	11	53
2019 March	95	11	106
2019 February	102	12	114
2019 January	81	5	86
2018 December	98	12	110
2018 November	170	1	171
2018 October	313	23	336
2018 September	84	15	99
2018 August	60	13	73
2018 July	37	9	46
2018 June	62	9	71
2018 May	83	18	101
2018 April	82	4	86
2018 March	87	16	103
2018 February	58	10	68
2018 January	85	6	91
2017 December	170	7	177
2017 November	43	9	52
2017 October	46	16	62
2017 September	36	22	58
2017 August	40	10	50
2017 July	37	8	45
2017 June	51	13	64
2017 May	62	7	69
2017 April	35	7	42
2017 March	57	53	110
2017 February	119	8	127
2017 January	53	8	61
2016 December	59	12	71
2016 November	75	5	80
2016 October	115	13	128
2016 September	116	9	125
2016 August	35	3	38
2016 July	37	4	41
2016 June	27	10	37
2016 May	25	5	30
2016 April	48	2	50
2016 March	96	23	119
2016 February	125	35	160
2016 January	97	21	118
2015 December	107	12	119
2015 November	105	17	122
2015 October	106	14	120
2015 September	91	18	109
2015 August	86	23	109
2015 July	115	13	128
2015 June	71	4	75
2015 May	86	13	99
2015 April	83	13	96
2015 March	86	4	90
2015 February	117	14	131
2015 January	91	14	105
2014 December	96	15	111
2014 November	74	13	87
2014 October	140	12	152
2014 September	73	9	82
2014 August	64	11	75
2014 July	82	16	98
2014 June	60	12	72
2014 May	80	21	101
2014 April	75	15	90
2014 March	77	21	98
2014 February	99	15	114
2014 January	92	14	106
2013 December	100	22	122
2013 November	84	23	107
2013 October	80	12	92
2013 September	76	21	97
2013 August	80	18	98
2013 July	75	25	100
2013 June	27	9	36

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