Abstract

Objective:

Dilated cardiomyopathy (DC) results from dilatation of one or both ventricles and is caused by systolic dysfunction. Rickets are a rare cause of DC. Here, we present a case series of DC due to rickets, which was successfully treated.

Materials and Methods:

Patients were followed-up at paediatric intensive care unit (ICU) with the diagnosis of DC-related heart failure, which was retrospectively evaluated. Patients with a disease other than hypocalcaemia and low vitamin D levels, which can cause heart failure, were excluded from this study.

Results:

Six patients who developed rickets-related heart failure were included in this study. The mean age of the patients was 6.4±3.2 months. All patients had growth developmental delay. Although most of the patients were admitted to the hospital due to respiratory distress, congestive heart failure findings were detected at the first examination of all the patients. The vitamin D levels of all patients were low. While the pre-treatment mean ejection fraction (EF) of the patients was 35.16% (±10.66), the post-treatment mean EF was found to be 55% (±9.83). Significant improvement in left ventricular function was observed post-treatment.

Conclusion:

In patients admitted to the ICU due to the diagnosis of heart failure, rickets should be considered and treated, considering that it can cause many other complications, including vitamin D deficiency, cardiomyopathy and cardiac dysfunction.

Keywords: Vitamin D deficiency, cardiomyopathy, rickets

References

  1. Akman I, Omeroglu RE, Dindar A. Can myocarditis and dilated cardiomyopathy be differentiated from each other in pediatric patients? Arch Turk Soc Cardiol 1994;22:38-42.
  2. Brown J, Nunez S, Russell M, Spurney C. Hypocalcemic rickets and dilated cardiomyopathy: case reports and review of literature. Pediatr Cardiol 2009;30:818-23.
  3. Ringer S. A further Contribution regarding the influence of the different Constituents of the Blood on the Contraction of the Heart. J Physiol 1883;4:29-42.3.
  4. Amirlak I, Al Dhaheri W, Narchi H. Dilated cardiomyopathy secondary to nutritional rickets. Ann Trop Paediatr 2008;28:227-30.
  5. Carlton-Conway D, Tulloh R, Wood L, Kanabar D. Vitamin D deficiency and cardiac failure in infancy. J R Soc Med 2004;97:238-9.
  6. Gillor A, Groneck P, Kaiser J, Schmitz-Stolbrink A. Kongestive Herzinsuffizienz bei Vitamin D-Mangel-Rachitis [Congestive heart failure in rickets caused by vitamin D deficiency]. Monatsschr Kinderheilkd 1989;137:108-10.
  7. 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;40:201-3.
  8. Elidrissy AT, Munawarah M, Alharbi KM. Hypocalcemic rachitic cardiomyopathy in infants. J Saudi Heart Assoc 2013;25:25-33.
  9. Ozkan B, Doneray H, Karacan M, Vançelik S, Yildirim ZK, Ozkan A, et al. Prevalence of vitamin D deficiency rickets in the eastern part of Turkey. Eur J Pediatr 2009;168:95-100.
  10. Yilmaz O, Olgun H, Ciftel M, Kilic O, Kartal I, Iskenderoglu NY, et al. Dilated cardiomyopathy secondary to rickets-related hypocalcaemia: eight case reports and a review of the literature. Cardiol Young 2015;25:261-6.
  11. Ari H, Ari S, Koca V, Bozat T. Geri dönüşümlü dilate kardiyomiyopatinin nadir bir nedeni: Hipokalsemi [A rare cause of reversible dilated cardiomyopathy: hypocalcemia]. Turk Kardiyol Dern Ars 2009;37:266-8.
  12. Jefferies JL, Towbin JA. Dilated cardiomyopathy. Lancet 2010;375:752-62.
  13. Högler W. Complications of vitamin D deficiency from the foetus to the infant: One cause, one prevention, but who’s responsibility? Best Pract Res Clin Endocrinol Metab 2015;29:385-98.
  14. TC Sağlık Bakanlığı. Bebeklerde D vitamini Yetersizliğinin Önlenmesi ve Kemik Sağlığının Geliştirilmesi Programı. Erişim tarihi: 1 Ocak 2005. Erişim Linki: http.//www.saglik.gov.tr/TR/belge/1-11576/bebeklerde-d-vitamini-yetersizliginin-onlenmesi-ve-kemik-htlm.
  15. TC Sağlık Bakanlığı. Gebelere D Vitamini Destek Programı. Erişim tarihi: 1 Ocak 2011. Erişim Linki: http://www.saglik.gov.tr/TR/belge/1-12656/gebelere-d-vitamini-destek-programi.

Copyright and license

Copyright © 2022 The Author(s). This is an open access article distributed under the Creative Commons Attribution License (CC BY), which permits unrestricted use, distribution, and reproduction in any medium or format, provided the original work is properly cited.

How to cite?

1.
Akçay N, Koçoğlu Barlas Ü, Papatya Çakır ED, Petmezci MT, Kıhtır HS, Yeşilbaş O, et al. Treatable Cause of Dilated Cardiomyopathy, Rickets; Two Years’ Experience. Turk J Intensive Care. 2022;20(2):65-71. https://doi.org/10.4274/tybd.galenos.2021.29392