Congestive heart failure in uremia is most often due to a variable combination of fluid overload, hypertensive cardiovascular disease, coronary artery disease, anemia, and arteriovenous fistula.1 -3 It may, on occasion, be due to calcification of the myocardium.4,5 We describe four uremic patients in whom intractable heart failure and atrioventricular block developed as a result of metastatic myocardial calcification.
The clinical, biochemical, and pathological findings of the cases are shown in the Table.
—A 26-year-old man was seen in September 1970, with a blood pressure of 240/170 mm Hg and bilateral papilledema. Urinalysis revealed protein (3+) and eight to ten red blood cells, with many granular casts per high-power field. The blood urea nitrogen (BUN) value was 25 mg/100 ml, and that for serum creatinine was 2.7 mg/100 ml. Blood pressure was lowered with the parenteral administration of hydralazine hydrochloride and diazoxide, and then