# Case Report: A case of myocardial calcification combined with abnormal Q waves on electrocardiogram

## TL;DR

A rare case shows that myocardial calcification in a dialysis patient can cause abnormal ECG findings, including pathological Q waves.

## Contribution

This case report highlights myocardial calcification as a potential cause of pathological Q waves in chronic kidney disease patients.

## Key findings

- A 24-year-old dialysis patient showed pathological Q waves and myocardial calcification on imaging.
- Severe focal calcification may disrupt electrical coupling and create electrically silent zones in the heart.
- CKD-related mineral metabolism disturbances can lead to metastatic myocardial calcification.

## Abstract

Myocardial infarction is the most common cause of pathological Q waves on electrocardiogram (ECG), but other conditions that cause myocardial injury or abnormal conduction (such as cardiomyopathy, myocarditis, cardiac tumors or amyloidosis, WPW, etc.) can also produce pathological Q waves. Whether myocardial calcification can lead to pathological Q waves remains uncertain.

A 24-year-old man with a solitary kidney and multiple childhood abdominal surgeries had been on maintenance hemodialysis since 2017 (three times weekly), with a dialysis vintage of approximately 8 years. He was admitted for left upper-limb swelling of 2 months’ duration. On admission his temperature was 36.6°C, blood pressure 93/75 mmHg, and heart rate 95 bpm. ECG showed complete left bundle branch block (cLBBB) and pathological Q waves in leads I, aVL, V5 and V6, without significant ST-T elevation. Transthoracic echocardiography(TTE) revealed global cardiac enlargement with marked systolic and diastolic dysfunction (LVEF ≈ 22%, LVEDD 80 mm), and an irregular hyperechoic mass at the cardiac apex measuring approximately 3.0 × 4.0 cm. Contrast chest CT confirmed focal calcifications in the high lateral wall and a hemispherical calcified lesion at the apex. Laboratory tests showed severe renal impairment (serum creatinine 827 µmol/L), markedly elevated NT-proBNP (32,961 pg/ml), mildly elevated troponin I (0.216 ng/ml) and myoglobin >1,000 ng/ml. Prior records documented severe disturbances of mineral metabolism: serum calcium 1.88 mmol/L, serum phosphorus 3.27 mmol/L, 25-OH vitamin D 13.05 ng/ml, and iPTH up to 2,000 pg/ml.

The patient underwent diagnostic evaluation, vascular access revision, and continued dialysis; his symptoms improved and he was discharged. He continues regular outpatient hemodialysis and is under follow-up.

We report a rare case of focal myocardial calcification with pathological Q waves in a maintenance dialysis patient. Chronic kidney disease (CKD)-related disturbances of calcium–phosphate metabolism can cause metastatic myocardial calcification. Severe focal calcification may produce mechanical compression and cell necrosis, disrupt electrical coupling, create electrically silent zones, and result in pathological Q waves. In CKD patients with abnormal ECG findings, myocardial calcification should be included in the differential diagnosis and evaluated using imaging and metabolic data.