Title : Heart of stone: A rare case of incidentally detected endocardial calcification
Abstract:
Background: Endocardial calcification is a rare cardiac condition with limited documented cases, particularly in non-tropical regions. This case report explores an unusual presentation of incidental endomyocardial calcification in a patient without typical predisposing systemic disorders.
Case Summary: A 76-year-old female with a history of hypertension and hyperlipidemia was evaluated for exertional chest pain and incidental left ventricular calcification. Despite presenting symptoms suggestive of coronary artery disease, comprehensive cardiac imaging revealed a unique pathological process. Advanced diagnostic techniques, including Positron Emission Tomography, Computed Tomography Angiography, and Cardiac Magnetic Resonance Imaging, were instrumental in characterizing the extent and nature of the cardiac abnormalities.
Initial diagnostic workup demonstrated preserved left ventricular ejection fraction (50-55%) with moderate left ventricular hypertrophy and diastolic dysfunction. Notably, comprehensive laboratory investigations excluded common calcification etiologies such as hypercalcemia, hyperparathyroidism, and sarcoidosis. The imaging studies revealed extensive endomyocardial calcifications without significant coronary artery stenosis, ultimately leading to a diagnosis of Idiopathic Calcific Cardiomyopathy (ICC).
Management and Outcome: Given the patient's stable clinical status, a conservative management approach was implemented. This included continued antihypertensive and lipid-lowering medications, regular cardiac monitoring through serial echocardiography, and patient education on medication adherence and lifestyle modifications.
Clinical Significance: This case highlights the importance of multimodality cardiac imaging in detecting subtle cardiac abnormalities, particularly in asymptomatic patients. It challenges the conventional understanding of endomyocardial calcification, which is typically associated with tropical regions and symptomatic heart failure. The presentation underscores the necessity of comprehensive diagnostic approaches when confronting atypical cardiac presentations.
Conclusion: The case contributes to the limited literature on incidental endomyocardial calcification, emphasizing the need for individualized diagnostic and management strategies. It calls for further research to elucidate the etiology, natural history, and optimal management of Idiopathic Calcific Cardiomyopathy.
