Vitamin D Deficiency Manifested by Premature Ventricular Complexes from RVOT: A Report on Two Twins

Gabriel Cismaru, Cecilia Lazea, Daniela Iacob, Simona Cainap

International Journal of Biomedicine. 2021;11(2):220-223.
DOI: 10.21103/Article11(2)_CR4
Originally published June 5, 2021


Vitamin D receptor is present in almost every cell of the body. Although some studies have suggested that values >30ng/ml would be sufficient, there is no consensus on the optimal values of serum vitamin D. Vitamin D deficiency can lead to “benign” manifestations, such as back pain, joint pain, fatigue, and heavy sweating. Premature ventricular contractions (PVCs) originating from the right ventricular outflow tract (RVOT) are considered “benign,” as they occur in patients without structural heart disease and their exact cause remains unknown. We describe the case of a 10-year-old boy with frequent PVCs and vitamin D deficiency that was corrected after vitamin D supplementation. On the contrary, his twin brother had normal serum vitamin D and no PVCs. The disappearance of PVCs occurred after treatment with vitamin D 2000 IU/day.

right ventricular outflow tract • twins • vitamin D • premature ventricular contractions • 24-hour Holter ECG
  1. Kiuchi MG, e Silva GR, Paz LMR, Chen Sh, Hoye NA, Souto GLL. Influence of vitamin D levels on the treatment of premature ventricular complexes in patients with chronic kidney disease. IJC Metabolic & Endocrine. 2017;14:53-58.
  2. Snellman G, Melhus H, Gedeborg R, Olofsson S, Wolk A, Pedersen NL, Michaëlsson K. Seasonal genetic influence on serum 25-hydroxyvitamin D levels: a twin study. PLoS One. 2009 Nov 13;4(11):e7747. doi: 10.1371/journal.pone.0007747. Erratum in: PLoS One. 2010;5(9) doi: 10.1371/annotation/e85fe043-b072-422d-acd5-9d27f02390b3. 
  3. Frasca D, Morganti G, Cherubini S. Un caso di rachitismo carenziale in una coppia di gemelli [Nutritional rickets in twins: a case report]. Pediatr Med Chir. 2013 May-Jun;35(3):130-3. doi: 10.4081/pmc.2013.46. [Article in Italian].
  4. Goswami D, Rani R, Saxena A, Arora MS, Batra S, Sreenivas V. Maternal and neonatal vitamin-D status in twin versus singleton pregnancies. J Obstet Gynaecol Res. 2016 Oct;42(10):1250-1257. doi: 10.1111/jog.13060. 
  5. Breslavsky A, Frand J, Matas Z, Boaz M, Barnea Z, Shargorodsky M. Effect of high doses of vitamin D on arterial properties, adiponectin, leptin and glucose homeostasis in type 2 diabetic patients. Clin Nutr. 2013 Dec;32(6):970-5. doi: 10.1016/j.clnu.2013.01.020. 
  6. Moghassemi S, Marjani A. The effect of short-term vitamin D supplementation on lipid profile and blood pressure in post-menopausal women: A randomized controlled trial. Iran J Nurs Midwifery Res. 2014 Sep;19(5):517-21.
  7. Ryu OH, Chung W, Lee S, Hong KS, Choi MG, Yoo HJ. The effect of high-dose vitamin D supplementation on insulin resistance and arterial stiffness in patients with type 2 diabetes. Korean J Intern Med. 2014 Sep;29(5):620-9. doi: 10.3904/kjim.2014.29.5.620. 
  8. Gepner AD, Ramamurthy R, Krueger DC, Korcarz CE, Binkley N, Stein JH. A prospective randomized controlled trial of the effects of vitamin D supplementation on cardiovascular disease risk. PLoS One. 2012;7(5):e36617. doi: 10.1371/journal.pone.0036617. 
  9. Gepner AD, Haller IV, Krueger DC, Korcarz CE, Binkley N, Stein JH. A randomized controlled trial of the effects of vitamin D supplementation on arterial stiffness and aortic blood pressure in Native American women. Atherosclerosis. 2015 Jun;240(2):526-8. doi: 10.1016/j.atherosclerosis.2015.04.795.
  10. Yiu YF, Yiu KH, Siu CW, Chan YH, Li SW, Wong LY, Lee SW, Tam S, Wong EW, Lau CP, Cheung BM, Tse HF. Randomized controlled trial of vitamin D supplement on endothelial function in patients with type 2 diabetes. Atherosclerosis. 2013 Mar;227(1):140-6. doi: 10.1016/j.atherosclerosis.2012.12.013.
  11. Muresan L, Cismaru G, Martins RP, Bataglia A, Rosu R, Puiu M, Gusetu G, Mada RO, Muresan C, Ispas DR, Le Bouar R, Diene LL, Rugina E, Levy J, Klein C, Sellal JM, Poull IM, Laurent G, de Chillou C. Recommendations for the use of electrophysiological study: Update 2018. Hellenic J Cardiol. 2019 Mar-Apr;60(2):82-100. doi: 10.1016/j.hjc.2018.09.002.
  12. Cismaru G, Mester P, Muresan L, Rosu R, Gusetu G, Puiu M, Pop D, Mircea PA, Zdrenghea D. Idiopathic ventricular premature contractions originating from the postero-lateral tricuspid annulus leading to left ventricular disfunction. Int J Clin Exp Med. 2015 Mar 15;8(3):4690-3. 
  13. Nelson DL, Lehninger AL, Cox MM.  Lehninger Principles of Biochemistry (5th ed.). New York: W.H. Freeman; 2008
  14. Weishaar RE, Kim SN, Saunders DE, Simpson RU. Involvement of vitamin D3 with cardiovascular function. III. Effects on physical and morphological properties. Am J Physiol. 1990 Jan;258(1 Pt 1):E134-42. doi: 10.1152/ajpendo.1990.258.1.E134. 
  15. Rostand SG, Drüeke TB. Parathyroid hormone, vitamin D, and cardiovascular disease in chronic renal failure. Kidney Int. 1999 Aug;56(2):383-92. doi: 10.1046/j.1523-1755.1999.00575.x. 
  16. Cismaru G, Gurzau D, Fringu F,  Martis A. Vitmamin D supplementation with Cardiac Rehabilitation reduces the number of RVOT Premature Ventricular Contractions.  Balneo Research Journal. 2020;11(4):566-568
  17. Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, Murad MH, Weaver CM; Endocrine Society. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2011 Jul;96(7):1911-30. doi: 10.1210/jc.2011-0385. Epub 2011 Jun 6. Erratum in: J Clin Endocrinol Metab. 2011 Dec;96(12):3908. 
  18. Garland CF, Gorham ED, Mohr SB, Garland FC. Vitamin D for cancer prevention: global perspective. Ann Epidemiol. 2009 Jul;19(7):468-83. doi: 10.1016/j.annepidem.2009.03.021.

Download Article
©2021 International Medical Research and Development Corporation.