J Cardiovasc Ultrasound.  2015 Dec;23(4):253-256. 10.4250/jcu.2015.23.4.253.

Recurrent Acute Decompensated Heart Failure Owing to Severe Iron Deficiency Anemia Caused by Inappropriate Habitual Bloodletting

• Lim WH
• Kim SH
• Kim HL
• Kim KH
• Na SH
• Lee HJ
• Kang EG
• Seo JB
• Chung WY
• Zo JH
• Hong JA
• Kim K
• Kim MA

• KMID: 2144456
• DOI: http://doi.org/10.4250/jcu.2015.23.4.253

Abstract

A 68-year-old woman visited the emergency department twice with symptoms of acute heart failure including shortness of breath, general weakness, and abdominal distension. Laboratory findings showed extremely low level of serum hemoglobin at 1.4 g/dL. Echocardiographic examination demonstrated dilated left ventricular cavity with systolic dysfunction and moderate amount of pericardial effusion. In this patient, acute heart failure due to severe iron deficiency anemia was caused by inappropriate habitual bloodletting.

Keyword

Heart failure; Anemia; Bloodletting

MeSH Terms

Aged
Anemia
Anemia, Iron-Deficiency*
Bloodletting*
Dyspnea
Echocardiography
Emergency Service, Hospital
Female
Heart Failure*
Heart*
Humans
Iron*
Pericardial Effusion
Iron

Figure

• 

  Fig. 1 The 12-lead electrocardiogram showed normal sinus rhythm at a rate of 75 bpm, right axis deviation, and poor R-wave progression.

• 

  Fig. 2 The initial chest radiography demonstrated marked cardiomegaly and pulmonary edema with bilateral pleural effusion (A). After treatment of acute heart failure and anemia, follow-up radiograph showed a modest regression of cardiomegaly and resolution of pulmonary edema and pleural effusion (B).

• 

  Fig. 3 The transthoracic echocardiography revealed dilated left ventricular (LV) cavity (LV end-diastolic dimension = 63 mm) with mild LV dysfunction, eccentric LV hypertrophy, left atrial enlargement and moderate amount of pericardial effusion (A and B). Right sided chambers were also enlarged and moderate mitral regurgitation was observed (C and D).

• 

  Fig. 4 The follow-up transthoracic echocardiography showed dilated left ventricular (LV) cavity (LV end-diastolic dimension = 56 mm) with low-normal LV function and small amount of pericardial effusion (A and B). Right sided chambers were still dilated and mitral regurgitation was reduced to mild degree (C and D).

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