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, 4вЂ“8 L/min) with a cardiac index of 2.7 L/min/m 2 (normal, 2.5вЂ“4 L/min/m 2). Cardiac pressures were measured: right atrium, 11/10/8 mmHg (normal, 2вЂ“7 / 2вЂ“7 / 1вЂ“5 mmHg) right ventricle, 45/7 mmHg (normal, 15вЂ“30 / 1вЂ“7 mmHg) pulmonary artery, 83/19 mmHg (normal, 15вЂ“30 / 4вЂ“12 mmHg) with a mean of 29 mmHg (normal, 9вЂ“19 mmHg) and mean pulmonary capillary wedge, 22 mmHg (normal, 4вЂ“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, 40вЂ“150 ng/mL), total iron-binding capacity, 428 ng/mL percent iron saturation, 3% (normal range, 16%вЂ“35%) and ferritin, 6 ng/mL (normal range, 13вЂ“150 ng/mL).ДЇig. 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.Д¬ase 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.

Weak and tremulous