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Dilated cardiomyopathy secondary to rickets-related hypocalcaemia: eight case reports and a review of the literature

  • Osman Yilmaz (a1), Hasim Olgun (a2), Murat Ciftel (a1), Omer Kilic (a3), Ibrahim Kartal (a4), Nebahat Y. Iskenderoglu (a4), Fuat Laloglu (a5) and Naci Ceviz (a2)...


Introduction: Dilated cardiomyopathy is usually idiopathic and may arise secondary to infections or metabolic or genetic causes. Another rare cause is hypocalcaemia. Owing to the fact that calcium plays an essential role in excitation and contraction of myocardial muscle, myocardial contractility may decline in patients with hypocalcaemia. Materials and Methods: Patients with symptoms of congestive heart failure and rickets-related hypocalcaemia were assessed clinically and by echocardiography in a paediatric cardiology clinic. Echocardiography was performed for all patients. Rickets was diagnosed according to the clinical, laboratory, and radiologic findings. Maternal lifestyle and living conditions were investigated, and the maternal 25-OH vitamin D3 blood level was measured. Results: We evaluated eight patients who developed heart failure as a result of severe hypocalcaemia associated with rickets between August, 1999 and June, 2012. The age distribution of the patients was 3–12 months. Laboratory results were consistent with advanced-stage rickets. Severe hypocalcaemia was detected in all patients. The maternal 25-OH vitamin D3 levels were low. Echocardiography revealed increased pre-treatment left ventricle end-systolic and end-diastolic diameters for age and reduced ejection fraction and fractional shortening. After clinical improvement, the patients were discharged. Conclusions: Severe hypocalcaemia associated with rickets must always be kept in mind among the causes of dilated cardiomyopathy and impaired cardiac function in infants. If diagnosed and treated in time, dilated cardiomyopathy and severe heart failure related to rickets respond well.


Corresponding author

Correspondence to: O. Kilic, Department of Pediatric Infectious Diseases, Erzurum District Training and Research Hospital, Erzurum, Turkey. Tel: +90 442 2325364; Fax: +90 442 2325090; E-mail:


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1. Hershberger, RE, Morales, A, Siegfried, JD. Clinical and genetic issues in dilated cardiomyopathy: a review for genetics professionals. Genet Med 2010; 12: 655667.
2. Kindel, SJ, Miller, EM, Gupta, R, et al. Pediatric cardiomyopathy: importance of genetic and metabolic evaluation. J Card Fail 2012; 18: 396403.
3. Verma, S, Khadwal, A, Chopra, K, Rohit, M, Singhi, S. Hypocalcemia nutritional rickets: a curable cause of dilated cardiomyopathy. J Trop Pediatr 2011; 57: 126128.
4. Ringer, S. A further contribution regarding the influence of the different constituents of the blood on the contraction of the heart. J Physiol 1883; 4: 2942.
5. Amirlak, I, Al Dhaheri, W, Narchi, H. Dilated cardiomyopathy secondary to nutritional rickets. Ann Trop Paediatr 2008; 28: 227230.
6. Carlton-Conway, D, Tulloh, R, Wood, L, Kanabar, D. Vitamin D deficiency and cardiac failure in infancy. J R Soc Med 2004; 97: 238239.
7. Gillor, A, Groneck, P, Kaiser, J, Schmitz-Stolbrink, A. Congestive heart failure in rickets caused by vitamin D deficiency. Monatsschr Kinderheilkd 1989; 137: 108110.
8. Kim, BG, Chang, SK, Kim, SM, Hwang, JS, Jung, JW. Dilated cardiomyopathy in a 2 month-old infant: a severe form of hypocalcemia with vitamin D deficient rickets. Korean Circ J 2010; 40: 201203.
9. Olgun, H, Ceviz, N, Ozkan, B. A case of dilated cardiomyopathy due to nutritional vitamin D deficiency rickets. Turk J Pediatr 2003; 45: 152154.
10. Price, DI, Stanford, LC Jr, Braden, DS, Ebeid, MR, Smith, JC. Hypocalcemic rickets: an unusual cause of dilated cardiomyopathy. Pediatr Cardiol 2003; 24: 510512.
11. Roy, R, El-Matary, W, Gladman, G, Isherwood, D. Dilated cardiomyopathy and adipic aciduria in nutritional rickets. Pediatr Emerg Care 2006; 22: 175176.
12. Fabi, M, Gesuete, V, Petrucci, R, Ragni, L. Dilated cardiomyopathy due to hypocalcaemic rickets: is it always a reversible condition? Cardiol Young 2012; 20: 14.
13. Ozkan, B, Buyukavci, M, Aksoy, H, Tan, H, Akdag, R. Incidence of rickets among 0–3-year-old children in Erzurum. Turkish Pediatr J 1999; 42: 389396.
14. Ozkan, B, Doneray, H, Karacan, M, et al. Prevalence of vitamin D deficiency rickets in the eastern part of Turkey. Eur J Pediatr 2009; 168: 95100.
15. Akman, I, Omeroglu, RE, Dindar, A. Can myocarditis and dilated cardiomyopathy be differentiated from each other in pediatric patients? Arch Turk Soc Cardiol 1994; 22: 3842.
16. Brown, J, Nunez, S, Russell, M, Spurney, C. Hypocalcemic rickets and dilated cardiomyopathy: case reports and review of literature. Pediatr Cardiol 2009; 30: 818823.
17. Andiran, N, Yordam, N, Ozön, A. Risk factors for vitamin D deficiency in breast-fed newborns and their mothers. Nutrition 2002; 18: 4750.
18. Orhan, F. Clinical characteristics of vitamin D deficiency rickets in infants in the ages of 0–6 months. Thesis. Erzurum 2006.
19. Vieth, R. Vitamin D supplementation, 25-hydroxyvitamin D concentrations, and safety. Am J Clin Nutr 1999; 69: 842856.
20. Hatun, S, Bereket, A, Calikoglu, AS, Ozkan, B. Vitamin D deficiency and nutritional rickets today. Turk Pediatr J 2003; 46: 224241.
21. Uysal, S, Kalayci, AG, Baysal, K. Cardiac functions in children with vitamin D deficiency rickets. Pediatr Cardiol 1999; 20: 283286.
22. Karademir, S, Altuntas, B, Tezic, T, Akinci, A, Demirceken, F. Left ventricular dysfunction due to hypocalcemia in a neonate. Jpn Heart J 1993; 34: 355359.
23. Kumar, M, Saikia, D, Kumar, V, Tomar, R. Vitamin D deficiency presenting with cardiogenic shock in an infant. Ann Pediatr Cardiol 2011; 4: 207209.
24. Nishikawa, T, Uto, K, Kanai, S, et al. Histopathological aspects of cardiac biopsy in pediatric patients with dilated cardiomyopathy. Pediatr Int 2011; 53: 350353.



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