DCM AND ANEMIA

[Vivi2711]

Respected & dear colleagues,

Diagnosed with DCM since May 2018 & is on carvedilol 3.125 mg twice daily, spironolactone plus toresemide 10 mg once daily, clopidegril 75 mg once daily, atorovastatin 10 mg once daily, losartan with potassium 25 mg once daily. CAG done. No blocks. LVEF was initially 39% after 3 months 36% and before a month 33%.

On salt / 1 litre fluid restriction daily.

From December 2018 my condition improved a lot and is almost asymptomatic therefrom. Walking briskly 4 kms daily. Started playing competetive table tennis last month and since heart rate exceeded my target & shortness of breadth intervened stopped it but continuing walking daily.

My lipids, sodium, choloride, carbonate blood sugar levels are always normal. BP is maintained at 90/60.

Before a fortnight my potassium rose upto 4.7 ( 4.5 they call as normal value) & serum creatinine jumped to 1.9 from 1.5.

My cardiologist advised me to stop losartan with potassium and increased the fluid limit from 1 litre to 1.5 litres daily which is being followed. I have cut down eating meat, poultry, bananas, pomegranate.

It is pertinent to note that right from May 2018 my HB is fluctuating between 9 to 10.5. I was before 4 months administered with ferric carboxymaxymaltose 50 mg /ml & in spite of that my HB before a fortnight is only 10.5.

I am apprehended as to whether this may be attributable to some other underlying cause and seek your esteemed advice on this issue.

Submitted with warm regards please.

M. Vivekanandan

[Fortepiano]

Anemia is very common in heart failure. My husband's anemia was treated with erythropoetin injections, but I think now IV iron ( not oral pills) is recommended.

The following is from the American College of cardiology:

'The European Society of Cardiology heart failure guidelines recommend that all patients with heart failure should be tested for anemia and iron deficiency with serum ferritin and transferrin saturations. The European guidelines recommend treatment with IV ferric carboxymaltose in symptomatic heart failure patients with iron deficiency to improve heart failure symptoms and quality of life (Class IIa, Level of Evidence A recommendation). The US guidelines do not recommend any specific formulation, but recommend IV iron in patients with heart failure and iron deficiency as a Class IIb, Level of Evidence B recommendation.'

Talk to your cardiologist about it.

All the best

[Vivi2711 in reply to Fortepiano]

Respected Fortepiano,

Thanks for your kind advice and I shall speak about an another dose of IV Ferric carboxymaltose to my cardiologist.

With utmost regards