Abstract
Byline: Maan Kathryn L Gozun, Internal Medicine, Univ of Hawaii, Honolulu, HI; Mohammed Ali; Todd Nagamine; Limpruttidham Nath; Kuo Alan Introduction: Moderate hypercalcemia may be well-tolerated, but rapid calcium deposition to the aortic valve may have life-threatening consequences. Clinical case: We present a case of a 77-year-old female with a history of retroperitoneal liposarcoma complicated by hypercalcemia. The patient had had recurrent hypercalcemia for the past 6 months, ranging from 12-14 mg/dL. She complained of 4 weeks of progressive dyspnea and orthopnea. Physical exam showed jugular venous distension and bilateral pitting edema. A transthoracic echocardiogram (TTE) showed critical aortic stenosis (AS) with a valve area of 0.4 cm2, peak velocity of 6 m/s, and a mean gradient of 90 mmHg (Figure 1). Her last TTE just 9 months prior showed mildly thickened aortic valve leaflets without evidence of stenosis with a valve area of 2.2 cm2, peak velocity of 1.4 m/s, and mean gradient of 4 mmHg (Figure 2). Discussion: The most common cause of AS is age-related calcification. However, the role of hypercalcemia in AS has not been well-defined. Typically, the valve area is expected to decline by 0.1cm2 per year. Surprisingly, our patient's valve area decreased from 2.2 cm2 to 0.4 cm2 in just 9 months. Rapid decline is usually associated with typical cardiovascular risk factors, however, studies have begun to recognize hypercalcemia as a potential risk factor for rapid progression. In our case, we believe our patient suffered from rapidly progressive AS secondary to chronic hypercalcemia due to malignancy. Conclusions: The severity of AS should be closely monitored in hypercalcemia and further studies are warranted to develop strategies for secondary prevention.