We report a 72-year-old man who presented to our emergency room with
congestive heart failure that was resistant to initial medical
therapy. He had suffered from anterior
myocardial infarction 20 years prior. Echocardiography and computed tomography revealed marked cardiac calcification including myocardium, chordal structures, mitral annulus, and aortic valve. Neither
chronic renal insufficiency nor
hypercalcemia were present in our patient.
Bone resorption markers were increased and bone mineral density was consistent with severe
osteoporosis. We suggested a novel mechanism, that increased
bone resorption may lead to accumulation of
calcium into avascular tissues in the heart (ie, chordal structures, mitral annulus, aortic valve, and fibronecrotic myocardium) especially in the setting of high left ventricular end-diastolic pressure. Dystrophic cardiac
calcinosis, an age-related
cardiomyopathy, is associated with elevated
bone resorption markers and it may cause alterations in cellular
calcium hemostasis with initiation of deleterious events leading to aggravate dilated and
restrictive cardiomyopathy and may result in intractable
congestive heart failure. The implication of this case report needs to be reemphasized.