Hypocalcemia is a less-recognized but reversible cause of heart failure. We report a 56-year-old gentleman with chronic kidney disease, coronary artery disease and hypertension, presenting with exertional dyspnea, orthopnea,and bilateral lower legs edema for one week. His jugular venous pulses were elevated. Cardiac examination revealed regular heart beat and an S3 gallop withoutmurmurs. Pertinent laboratory data revealed plasma creatinine 4.2mg/dL and elevated creatinine kinase (585 IU/L). Electrocardiography showed normal sinus rhythm with nonspecific ST-T
changes and a corrected QT (QTc) interval of 0.7 seconds (normal 0.36-0.43 seconds). Echocardiography demonstrated generalized hypokinesia of the left ventricle with ejection fraction of 20-25%. Aggressive therapy
with carvedilol, spironolactone, intravenous nitroglycerin and furosemide failed to ameliorate the patient’s clinical symptoms. Later, marked hypocalcemia (plasma total calcium 4.28 mg/dL) was noted, and a normalization of serum calcium concentration improved the heart failure dramatically. Early recognition of hypocalcemia as a precipitating
factor of congestive heart failure will promote the rapid initiation of effective therapy.