Hypocalcemia is a very rare cause of dilated cardiomyopathy with alteration more or less of the contractile function of left ventricle (LV). It is complicated rarely with heart failure.

We report two cases admitted to the cardiology department of the University Hospital Mohammed VI in Marrakech for congestive heart failure secondary to severe hypocalcemia.

Case 1 .– A 29-year-old female was admitted in our hospital due to congestive heart failure with dyspnea (NYHA class IV) and generalized oedema for 2 days. She had a history of total thyroidectomie one year ago due to thyroidien goiter. She had taken synthyroid as a daily medication associated to calcium supplementation and vitamin D because of hypoparathyroidia. Patient was not compliant to treatment. Laboratory tests revealed severe hypocalcemia. Transthoracic echocardiography (TTE) showed a dilated LV with global hypokinesia and an ejection fraction (EF) at 25% and mild mitral regurgitation. A marked clinical improvement was noted after correction of hypocalcemia. Four months later, we observed a total recovery of LV function.

Case 2 .– A 44-year-old male, without particular medical history, who was hospitalized for a congestive heart failure. TTE showed a dilated LV with severe alteration of systolic function (EF to 20%). Laboratory tests showed hypocalcemia, with decreased of a parathyroid hormone. There was improvement of symptoms after correction of metabolic disorder. The ventricle has gradually recovered its performance.

Hypocalcemia is an unrecognized cause of heart failure with a favorable prognosis. However, it requires a specific care.