“Porcelain heart” a case of acute heart failure with massive myocardial calcification complicated with primary hyperparathyroidism

A 47-year-old Japanese woman was transported to our hospital due to acute heart failure (AHF). She had been diagnosed with primary hyperparathyroidism (pHPT) and undergone parathyroidectomy 3 months previously. Chest X-ray showed marked cardiomegaly and severe pulmonary congestion, and transthoracic echocardiography indicated both left ventricular (LV) systolic and diastolic dysfunction, complicated with extensive massive myocardial calcification and no LV hypertrophy. Computed tomography also showed massive myocardial calcification in the posterior wall of the LV and the interventricular septum. After treatment with furosemide, olprinone, and carperitide under Swan-Ganz monitoring, LV ejection fraction was almost normalized. However, cardiac catheterization in the chronic phase indicated that LV diastolic dysfunction still existed, which might be affected by myocardial calcification. We followed this patient using spironolactone (25 mg/day), perindopril (8 mg/day), and bisoprolol (1.25 mg/day), with no further episode of heart failure for at least 6 months. Here, we report a rare case of AHF complicated with massive myocardial calcification possibly caused by primary hyperparathyroidism.