Anemia and the Heart

By Stephen T. Sinatra, M.D., F.A.C.C., F.A.C.N., C.N.S., C.B.T.

It’s truly amazing how conditions that seemingly have nothing to do with the heart actually do impact heart health. It shows just how interconnected every single body part and system really is.

Anemia is a perfect example. Anemia is a condition that occurs when you don’t have enough red blood cells, or when your red blood cells don’t contain enough hemoglobin—the iron-rich protein that gives blood its red color. Hemoglobin helps red blood cells carry oxygen from the lungs to the rest of your organs and tissues.

Anemia Symptoms

Wondering if you’re anemic? Symptoms can vary. The most common is weakness, fatigue, and/or tiredness. Other symptoms of anemia may include shortness of breath, dizziness, headache, rapid heartbeat, irritability, and mental confusion.

One of the most interesting and unusual anemia symptoms is called pica. This is the habit of craving and eating unusual substances that have no nutritional value, such as ice, dirt, clay, even paper or cardboard! I’ll never forget a woman I went to medical school with who was a chronic ice chewer. I mean, she was seriously addicted to ice! We later found out she was anemic.

What Causes Anemic Symptoms?

Anemia strikes for a variety of reasons. The most common cause is iron deficiency. When the body lacks the iron needed to produce hemoglobin, anemia symptoms often kick in promptly. This usually occurs when you don’t get enough iron in the diet or, much more commonly, with blood loss. Women who have heavy menstrual periods run the risk of iron deficiency, as well as anyone who suffers from ulcers, gastritis, colon polyps, intestinal diseases, or any other condition that triggers bleeding. Anemia is also common in pregnancy, as a woman’s body needs to make additional blood to support a growing fetus.

Another form of anemia, megaloblastic anemia, results from folate or vitamin B12 deficiencies. Inadequate levels of these vitamins cause atypically large red blood cells that have a shorter-than-normal lifespan.

Other anemia causes include medical treatments such as chemotherapy and radiation, as well as the use of certain pharmaceuticals like antibiotics, seizure medications, immunosuppressants, and anticlotting drugs.

Anemia of Chronic Disease

The anemia cause that concerns me most as a cardiologist is what’s called “anemia of chronic disease.” With this form of anemia, the body does not efficiently recycle iron from blood cells, so they do not live as long as they should. The body also stops responding properly to erythropoietin, a hormone produced by the kidneys that’s responsible for boosting red blood cell production.

People with certain long-term medical conditions that involve inflammation, including some cancers and autoimmune disorders, hepatitis, kidney disease, and congestive heart failure (CHF) often become anemic. In fact, a meta-analysis of 34 studies and more than 153,000 CHF patients found that 37.2 percent of them had anemia. After a six-month follow-up, 46.8 percent of the anemic patients died compared with 29.5 percent without anemia.

Anemia also causes reduced blood flow to the kidneys, which leads to fluid retention, which places even further stress on the heart. Additionally, chronic anemia can result in left ventricular hypertrophy, the enlargement and thickening of the walls of the left ventricle—the heart’s main pumping chamber. This can worsen congestive heart failure and set up what researchers call a vicious cycle “wherein CHF causes anemia, and the anemia causes more CHF, and both damage the kidneys, worsening the anemia and the CHF further.”

So, yeah, I get concerned about anemia in patients with heart failure…and heart attack and other heart diseases. Decreased oxygen delivery leads to increased cardiac output. Simply put, this means the heart has to work much, much harder to do its job. Not only do nearly half of patients hospitalized for heart attack have anemia, people with anemia have a much higher risk of having a heart attack.

How to Treat Anemia

If you’re suffering from symptoms of anemia, see your doctor. He/she can run the appropriate tests, check for underlying health problems, and prescribe the right course of treatment.

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What should you expect? In most cases, anemia treatment involves supplementing with iron (and/or folate or B12, if needed). If the underlying cause of anemia is blood loss (other than menstruation), then the source of the bleeding should also be located and stopped. Usually, that’s all it takes to solve the problem.

With anemia of chronic disease, though, more extensive treatment may be needed. Some research has shown that, in severe cases, blood transfusions, intravenous delivery of iron, and injections of erythropoietin can be very helpful.

One caveat…It’s important to keep in mind that iron can be a pro-oxidant, meaning it can lead to greater oxidative stress in the body if not used correctly. For this reason, the only people who should supplement with iron as a matter of course are menstruating and pregnant women. Iron supplementation is usually safe for children, but discuss dosing with your child’s pediatrician beforehand. Men, postmenopausal women, and all others should only take iron under the care and supervision of their doctors.


© Stephen Sinatra, MD. All rights reserved.

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