Hearts of Stone

That term “Hearts of Stone” is used frequently to discuss excess coronary artery calcification (CAC). I wrote about increased CAC and its causes in this blog on March 26, 2020. The Journal of the American College of Cardiology (JACC) recently published a state-of-the-art review on managing another form of stone hearts, severe mitral annular calcification (MAC) (Chehab et. al. Management of Patients with Severe Mitral Annular Calcification. JACC. 80:722–738). The introduction mentions that MAC is associated with atherosclerotic risk factors, including dialysis-dependent renal failure. It does not mention hyperparathyroidism, which is a recognized cause of MAC and which can also cause coronary , aortic valve , and myocardial calcifications. I was going to send a letter to the editor, but JACC does not accept letters on reviews. So, I am blogging it instead to remind clinicians to at least think about hyperparathyroidism. I often measure a parathyroid level and a calcium in folks sent to me with coronary artery calcification scores that seem excessive for their risk factors. One of our fellows wrote this up (Elsadany M, Thompson PD. Hyperparathyroidism possibly causing increased coroanry artery calcification. Am J Cardiol. 2022 Jun 1;172:164–165.). I hope this information is useful to you.