Cardiac failure secondary to hypocalcaemia of nutritional osteomalacia

A 41-year-old Asian woman presented with mild congestive cardiac failure, initially controlled with a small dose of diuretic. Subsequently there was a marked deterioration in her condition with severe cardiac failure resistant to treatment. At this time biochemistry revealed a hyperphosphataemic variety of osteomalacia. Her cardiac failure improved promptly on correcting the hypocalcemia. Although hypocalcaemia is a recognised cause of cardiac failure it has not been described in privational osteomalacia.