HEARTS OF IRON IV BETA FULL
In 1830, as therapeutic bloodletting was falling out of favor, Marshall Hall commented that “if, instead of one full bleeding, … the person be subjected to repeated blood-lettings, … the action of the heart and arteries is morbidly increased, and there are great palpitation, … the pulse varies from 100 to 120 or 130…. The deleterious effects of anemia on the heart have long been recognized.
HEARTS OF IRON IV BETA FREE
At her last follow-up visit, in November 2004, she remained free of signs and symptoms of cardiac dysfunction. A myocardial biopsy was not obtained, because suspicion of high-output heart failure was strong and her recovery was rapid. Her hemoglobin and hematocrit levels had normalized by the time of the repeat echocardiogram. A repeat echocardiogram obtained 10 weeks after the 1st one showed normal systolic function of the left ventricle with only trace (0–+1) mitral regurgitation. The furosemide and lisinopril were discontinued. At her 2-week follow-up appointment, she was free of signs and symptoms of heart failure. At discharge, her hemoglobin level was 10.3 g/dL and her hematocrit level was 33.7%.
She was discharged from the hospital with a prescription for iron sulfate (325 mg, 3 times a day). The patient was given furosemide and lisinopril, and she was gradually weaned from supplemental oxygen. Right and left heart catheterization showed normal coronary arteries, moderate global LV dysfunction with an ejection fraction of 0.30, moderate pulmonary hypertension, and moderate mitral regurgitation. Her cardiac output was 3.8 L/min (normal, 4–8 L/min) with a cardiac index of 2.7 L/min/m 2 (normal, 2.5–4 L/min/m 2). Cardiac pressures were measured: right atrium, 11/10/8 mmHg (normal, 2–7 / 2–7 / 1–5 mmHg) right ventricle, 45/7 mmHg (normal, 15–30 / 1–7 mmHg) pulmonary artery, 83/19 mmHg (normal, 15–30 / 4–12 mmHg) with a mean of 29 mmHg (normal, 9–19 mmHg) and mean pulmonary capillary wedge, 22 mmHg (normal, 4–12 mmHg). Transesophageal echocardiography revealed a structurally normal mitral valve. 2 After colonoscopy, a chest radiograph showed signs of pulmonary congestion: patchy bilateral alveolar opacities and small bilateral pleural effusions. Results of iron studies revealed iron-deficiency anemia, with an iron level of 12 ng/mL (normal range, 40–150 ng/mL), total iron-binding capacity, 428 ng/mL percent iron saturation, 3% (normal range, 16%–35%) and ferritin, 6 ng/mL (normal range, 13–150 ng/mL).įig. The patient received 3 units of packed red blood cells and was admitted for evaluation of anemia. Stool guaiac tests were negative for occult blood. The rest of the hemogram results, along with the chemistry and coagulation panels, were normal. The initial hemoglobin level was 4.6 g/dL, the hematocrit level was 16.9%, the mean corpuscular volume was 71.3 fL, and the red-cell distribution width was 21.3%. A right bundle branch block with borderline LV hypertrophy and multiple atrial ectopic beats were present on the electrocardiogram (ECG). Signs of congestive heart failure were absent. Physical examination was notable only for conjunctival pallor and a hyperdynamic precordium. She smoked tobacco and infrequently drank alcoholic beverages. In June 2004, a 42-year-old woman presented at the emergency department of our institution with menorrhagia and a 2-month history of fatigue and exertional dyspnea. We also describe a representative case.Ĭase Report. Despite numerous published observations regarding the effects of iron-deficiency anemia on the heart, ours is the 1st review of the cardiomyopathy of iron deficiency in the English-language medical literature. Severe iron deficiency can produce left ventricular (LV) dysfunction and overt heart failure. When the anemia is more significant, dyspnea and fatigue may occur. In mild cases, patients are asymptomatic. Iron-deficiency anemia is the most common form of nutritional anemia in both developed and developing countries.
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