Anaemia may result in heart failure

Chennai: Ramya, a 9-year-old girl, complained of severe heartache combined with drowsiness. When taken to the hospital she was told that her iron deficiency may be the reason for this major heart problem. “I am an anaemic and fall sick often. I don’t know how I developed a heart problem. Doctors say that it might be due to the anaemic condition that I have developed the disease,” says Ramya.

Anaemia, or low haemoglobin level in the blood, is often linked to heart disease because the heart has to work harder to pump more blood and oxygen through the body.

When asked, a haematologist, Dr Varadarajan said that if a child is anaemic, the blood becomes dilute. “The dilution of blood means that when the total number of red blood corpuscles (RBC) is low, the blood is dilute resulting in lower volume of the blood. It will subsequently lead to heart failure. The heart fails to function because it finds it difficult to pump out the blood as the volume of blood is lesser,” he said.

When someone is anaemic, the body doesn’t get the oxygen that it needs. If anaemia is unrecognized and untreated, serious damage can occur in the organs.

“If anaemia becomes severe, the heart has to pump harder and faster to compensate for the decreased oxygen levels in the body,” says Dr M Vijaya Kumar, cardiologist at Vijaya Heart Foundation. People who already have heart disease may actually worsen their condition if they also develop anaemia because decreased oxygen places additional strain on the heart, he added.

Anaemia can lead to a rapid or irregular heartbeat (arrhythmia). When you’re anaemic your heart must pump more blood to compensate for the lack of oxygen in the blood. This can lead to an enlarged heart or heart failure. Anaemia has been found to be a common complication of chronic heart failure (CHF), reducing oxygen delivery to the periphery.

Talking about chronic anaemia, senior cardiologist Stephen T. Sinatra in his article, ‘Anaemia and the heart’, says that anaemia also causes reduced blood flow to the kidneys, which leads to fluid retention, which places even further stress on the heart.

Additionally, chronic anaemia 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 anaemia and the anaemia causes more CHF and both damage the kidneys, worsening the anaemia and the CHF further,” he said.

Chronic heart failure or CHF is frequently associated with poor exercise tolerance and weakening symptoms despite modern treatment. In the past, we expected that this was due to the direct consequences of poor cardiac output and congested lungs.

Other important pathophysiological disturbances in chronic heart failure occur as both short and long term consequences of the initial cardiac dysfunction. These include neurohormonal activation, cytokine release and trophic changes in skeletal muscle and the peripheral vasculature, and disturbances in reflex control systems.