Severe Hypocalcemia Causing Acute Heart Failure Decompensation with Exacerbation of Mitral and Tricuspid Regurgitation

Abstract Hypocalcemia can lead to arrhythmias and to left ventricular dysfunction. We present herein this case of a 93 years old man with multiple myeloma (MM) who developed severe hypocalcemia secondary to treatment with Zoledronic acid. The severe hypocalcemia induced by Zoledronic acid led to acute decompensation of stable heart failure (HF) and to an increase of the mitral and tricuspid regurgitation severity with pulmonary edema requiring intubation, mechanical ventilation and inotropic support. Correction of the hypocalcemia using intravenous calcium gluconate reversed the cardiac decompensation and improved the mitral and tricuspid regurgitation as demonstrated by transthoracic echocardiography, with an improvement in the clinical condition of the patient.