Question :)

[CarlaW]

Hi Dr. Fett,

I have a question regarding iron levels and heart function. I saw my GP yesterday due to feeling extremely fatigued for the past three weeks (after a tummy bug) and have had an increase in heart palpatations. My resting pulse rate was also high so my Dr ordered some blood tests to check kidney function, iron and thyroid levels for me. Today I felt worse, and was told to come back in and see a different Dr as my GP only works Mon-Weds. The Dr I saw today told me that my haemoglobin levels are fine (not anemic), but my iron stores (ferritin?) are low. It was 7, normal is above 15. She told me it was nothing to worry about. I understand though that anaemia can affect pulse rate, can having low iron stores as well? Would this be contributing to the tiredness? Thank you for your time, I greatly appreciate it. :)

[JAMESFETT]

Yes, both anemia with low ferritin and no anemia but low ferritin can have an effect on the heart, its function and heart rhythms. The medical literature has a developing trend of articles on this very topic, although the exact mechanisms of that happening are not yet well understood. Your low ferritin indicates need to continue to replenish your iron stores by supplemental iron in order to prevent the anemia from happening or else in order to continue to improve the situation, not sure if you were actually anemic earlier. Women's iron stores are more often depleted (than men's) because of pregnancies and menstrual periods. For any heart condition, normal hemoglobin and normal iron stores (but not too much) are very important for recovery; and low hemoglobin and low iron stores in that situation cause extra stress on heart function.

JD

[CarlaW]

Thank you for your reply, it is greatly appreciated! I didn't get the feeling that the dr. yesterday was listening to me, so I will make an appointment with my regular GP next week and discuss this with her. Thanks!

[JAMESFETT]

I recently reviewed a fine medical article by a group from Italy about this very subject, showing the importance of iron stores on heart function. The article will be appearing in the International Journal of Cardiology. Many other articles also deal with and confirm the importance of this issue.

JD

[CarlaW]

Thank you, that's really interesting. I've always had trouble with my ferritin levels as I don't eat red meat. Before I had my children I remember a test coming back where my levels were 9, but I'm pretty sure I was told no anaemia, and I was given iron supplements so I was confused yesterday. I queried it with two nurses and the Doctor, and they all said it was OK since I wasn't anaemic! They wanted to increase my carvedilol instead, but I refused as my cardiologist had told me AND sent a letter to these Drs saying not to increase my meds any further at this time. I will print this out and have a look at some of the journal articals as well if I can find them, and then pass them on to my GP. Thank you for you time :)

[CarlaW]

Thank you for all your help, I just wanted to let you know I called my Drs office this afternoon and told the nurse I wasn't happy and I wanted iron supplements. I told her what you had said, and what the medical literature suggests. She called me back an hour later, having talked to the GP on today and my cardiologist and told me the cardiologist agreed with me so the GP wrote me out a script, and thanked me for educating her on something she wasn't aware of before!

So thank you, your advie gave me the courage to keep asking questions until I was happy, AND hopefully will mean that people will be treated correctly in the future by this Dr. :)

[mygirl22]

I just joined here this week. You should know that I think this site is a Godsend. I have had so many questions and concerns and I often feel like my doctor takes for granted that I am an otherwise healthy 25year old and blows me off. And it seems like he has a "Don't ask Don't tell" policy. It seems as though if I don't have a list of questions, he's not giong to just volunteer the info. So I am left trying to come up with Q's... Anyway- My EF at last check was 60%, I am down to only taking 1 20mg Lisinopril daily, and I have Mitral Valve Prolapse w/regurgitation as a result of my PPCM/CHF. I am 8mos post partum now and all too often feel too tired to function even when I rest well at night. I am more scatterbrained than I used to be before this extreme fatigue, I get chest pains off and on and lately (in the last week or so), I have palpitations all through the day that seem to fatigue me more and dampen my mood! When I mentioned all this to my Cardiologist a few weeks ago he literally said to ignore my chest pains and get used to them and that I should feel better coming off some meds (Spironolactone and Coreg). Well, for a couple weeks I felt better than I had in 8 mos but I feel like crap here lately. Should I be concerned? I am thinking about changing doctors... Please help me!!

[JAMESFETT]

Yes, those are all questions that need answers.
1)Chest pain: often seen with PPCM; first need to be sure not due to coronary artery disease (angina pectoris). Once that question is resolved, all other causes are less dangerous, and often turn out to be chest wall pain i.e. due to muscle, joints, cartilage, ligaments.
2)Palpitations: Most probably, with normal EF, these are harmless extra beats; but one needs to be sure there are no serious rhythm problems; and the only way I know to do that is by Holter monitor or event monitor.
3)Don't feel as good after DC Coreg. Has your EF changed with that? Because we don't know the best time to discontinue meds, I keep the beta-blocker (metoprolol or carvedilol--Coreg in your case) going for a full year after diagnosis. During that first year after diagnosis I first phase out diuretics, next ACE-inhibitor (Lisinopril in your case), and last of all the beta-blocker.
4)Mitral valve: It is common in PPCM to have enlargement of the mitral valve ring and resultant regurgitation. This is almost never a practical problem and decreases or disappears as the size of the left ventricle returns to normal. On the other hand, prolapse of the mitral valve is a separate process, is also very common, and usually not a practical hemodynamic problem, except in a very few. So, if, with EF 60 percent you have mitral valve prolapse, I would think that is a pre-existing phenomenon, and again, usually not a problem.

So, I don't ignore chest pain nor palpitations, without first knowing what the chest pain is due to, or at least to be sure there is no coronary artery disease, which seems unlikely young age, but does happen in USA; and without first knowing what are the palpitations--are they premature ventricular contractions, are they premature atrial complexes, or are they of more serious nature?

Congratulations on recovery of EF!!!

JD

[mygirl22]

Thanks for your insight doctor. I went to the ER 3 weeks ago because of the chest pains (they had a sudden onset for the 1st time ever)- apparently my Chest Xray and blood work were normal and the ER doctor said that I probably needed a better bra for more support/chest wall inflammation and prescribed me 900mg Motrin. I even told them that my cardio said don't take IB Profin and they gave it to me anyway. A few days later my cardio said that chest pain was from the MVP and was normal and DO NOT take the meds from the ER. I am so tired of these inconsistensies. Cardio took me off of coreg and Spironolactone because my blood pressure was low after telling me a few months earlier than I am prone to high blood pressure now. I haven't had my EF rechecked since I came off Coreg 3-4 wks ago. I just fear that I will drop dead one from Sudden Cardiac Death one day because no one knows what they are talking about!! Then I feel bad all over again for thinking I am paranoid and should move on with my life and take it all into stride. ??? Can anyone relate??