Cardiomyopathie dilatée hypocalcémique réversible induite par un hypoparathyroïdisme secondaire décompensé après une infection à la Covid-19 : à propos d’un cas

Abstract

Introduction

Hypocalcemia, though rare, can lead to heart failure with reduced ejection fraction and dilated cardiomyopathy. It may result from various etiologies, and its manifestations range from mild to life-threatening. Cardiovascular complications of hypocalcemia include QT interval prolongation, ventricular arrhythmias, and heart failure.we report a rare case of reversible hypocalcemic dilated cardiomyopathy.

Case Report

We present the case of a 41-year-old woman with secondary hypoparathyroidism following thyroidectomy in 2018. She was treated with levothyroxine, calcitriol, and calcium and vitamin D supplements. Following a Covid-19 infection in May 2021, her hypoparathyroidism decompensated, leading to severe hypocalcemia, which was inadequately managed. Five months later, she presented with worsening dyspnea, orthopnea, and bilateral lower limb edema. Clinical examination revealed positive Chvostek and Trousseau’s signs, indicating severe hypocalcemia. ECG showed sinus tachycardia with QT prolongation, and echocardiography revealed a dilated left ventricle with an ejection fraction (EF) of 29%. Despite normal coronary angiography, a CT scan showed bilateral pleural effusion and superior vena cava thrombosis. Laboratory findings confirmed hypocalcemia with elevated phosphorus and low parathyroid hormone levels. Intravenous calcium correction and heart failure management led to symptomatic improvement and normalization of serum calcium within one week. Echocardiography showed gradual recovery, with EF improving to 38% at 8 weeks and 57% after 6 months.

Discussion

Calcium plays a critical role in cardiac contractility, and its deficiency can severely impact myocardial function. Hypocalcemia following thyroidectomy is a known complication and can worsen during systemic infections like Covid-19. While hypocalcemia-induced cardiomyopathy is reversible with proper treatment, it requires early recognition and aggressive correction. *

Conclusion

This case highlights the importance of monitoring calcium levels in patients with hypoparathyroidism, especially in the context of systemic infections, to prevent potentially life-threatening complications like hypocalcemic cardiomyopathy. Proper diagnosis and treatment of hypocalcemia can lead to full recovery of cardiac function