Stone heart: An unusual case of heart failure with preserved ejection fraction due to massive myocardial calcification.

We report an unusual case of heart failure due to massive myocardial calcification related to a rare combination of idiopathic mitral annular calcification, myocardial calcification of the left ventricular septum and the inferior wall without other predisposing factors, such as previous myocardial infarction, ventricular aneurysms, myocarditis, rheumatic heart disease, tuberculosis, chronic renal failure, or systemic metabolic disease (sarcoidosis or primary hyperoxaluria). The related restrictive pattern of diastolic filling of the left ventricle could explain this unusual case of heart failure with preserved ejection fraction. <Learning objective: The prevalence of heart failure with preserved ejection fraction has increased with an increasing prevalence of risk factors. For patients presenting with heart failure and normal left ventricular (LV) ejection fraction, many causes should be excluded. We make the argument that massive myocardial calcification related to a combination of idiopathic mitral annular calcification, myocardial calcification of the LV septum and the inferior wall without other predisposing factors may serve as an uncommon mechanism of heart failure with preserved ejection fraction.>.