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Heart of Stone

      A 36-year-old woman with a history of diabetes mellitus, hypertension, and hemodialysis-dependent renal failure presented with severe biventricular heart failure. Echocardiography revealed normal systolic function with a restrictive pattern of diastolic filling and unusually bright echoes in the posterior wall of the left ventricle. Noncontrast computed tomography showed extensive calcification involving the ventricular myocardium of the septum (straight arrows) and posterior wall (curved arrows). The diffuse intravascular calcification also resulted in a spontaneous arteriogram (arrowheads). Laboratory studies included the following (reference range shown parenthetically): calcium, 8.1 mg/dL (8.9-10.1 mg/dL); phosphorus, 7.5 mg/dL (2.5-4.5 mg/dL); and parathyroid hormone, 29 pmol/L (1.1-5.8 pmol/L). This severe form of calciphylaxis causing diastolic heart failure from a “heart of stone” was the result of her long-standing renal disease with secondary hyperparathyroidism. Given the extremely poor prognosis and irreversibility of this condition, early recognition and management of renal failure and management of the calcium-phosphorus balance are of key importance.