Hemoglobin is responsible for carrying oxygen to all the organs of the body. However, a decrease of hemoglobin below normal levels leads to anemia, which can be detrimental to the heart.
Dr Sumanta Chatterjee, interventional cardiologist, AMRI Hospital, Dhakuria, Kolkata, explains, “Anemia refers to low hemoglobin level. So, if there is an iron deficiency, it leads to anemia (as iron is required to produce hemoglobin). The causes can be many. In case of anemia, there is a demand-supply mismatch, where the demand (for hemoglobin) is more and supply is less. To make up the demand, the heart has to pump more.” It can cause chest pain and contribute to the risk of heart attacks. In addition, hemoglobin levels being low for prolonged periods can lead to high-output heart failure as it affects the overall blood circulation.
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Dr Mala Kaneria, consultant, Infectious diseases, Jaslok Hospital & Research Centre, Mumbai, adds, “Anemia can occur due to iron deficiency which can result from poor iron intake or blood loss (like excessive menstrual blood loss in women). Anemia may be acute or chronic, which can occur due to nutritional deficiencies (such as folic acid and vitamin B12) or excessive destruction of red blood cells in the body (hemolysis).”
Signs of anemic heart failure
Anemia can cause fatigue, weakness, light-headedness, tingling or numbness of the extremities, chest pain, yellowing of the eyes and even irregular heartbeat. When anemia leads to heart failure, there may be extreme fatigue, shortness of breath and swelling of the feet. “Chest pain is an unusual or rare symptom of anemia. Many times, it presents with respiratory issues,” says Dr Chatterjee.
Dr Kaneria adds, “Hypertension can also be a manifestation or symptom of severe anemia, where the heart is forced to pump blood harder due to the increased demand for oxygen.”
There is also a link between chronic kidney disease and heart disease (called cardiorenal syndrome). Anemia plays a role there, says Dr Chatterjee. An article published in 2013 also states that chronic kidney disease and anemia are among the most frequent comorbid conditions in people with heart failure.
How does anemia affect the heart?
Any type of anemia can cause heart issues. Dr Chatterjee says, “Thalassemia is a common type of chronic anemia where the hemoglobin level is abnormal. Not that the hemoglobin is less, but the useful hemoglobin, which we call hemoglobin A is less. In people with thalassemia and beta-thalassemia major, there is an iron overload which can also cause heart failure.”
Dr Kaneria adds that the problem is more severe in individuals who already have a compromised heart due to an underlying cardiac condition. They tolerate anemia poorly. “The presence of anemia can create difficulty in the treatment of heart failure, as the compromised heart with a poor ejection fraction cannot adequately compensate for low hemoglobin levels,” she says.
Dr Chatterjee says, “In people with ischemic or coronary heart disease, if the hemoglobin level is less than 9 g/dL, we usually postpone heart procedures like angioplasty and bypass surgery.”
What is the normal hemoglobin level?
Anemia should ideally be detected and treated early before it progresses to heart failure. Dr Chatterjee says that a basic test like echocardiography is advised to people with anemia to rule out any heart problems. If one has a heart problem, they are recommended to get regular blood work done to keep a check on their hemoglobin levels.
Dr Kaneria adds, “However, even if the heart is affected, it can be resolved by careful (without burdening an already compromised heart) blood transfusions. Normal hemoglobin range is between 12 to 15 g/dL in females and 12.5 to 17 g/dL in males. Pregnant women tend to have lower hemoglobin levels due to the physiological changes associated with pregnancy.”
How to treat low hemoglobin levels?
Iron levels can be improved through blood transfusion in case of acute blood loss. “In case of long-standing iron deficiency, parenteral (injection) and oral iron supplementation are administered depending on the urgency of the situation,” says Dr Kaneria.
Takeaways
- Anemia can be detrimental to the heart as it can lead to heart failure if left unchecked and untreated for a long time.
- Various symptoms like fatigue, weakness, light headedness, chest pain and even irregular heartbeat can result from anemia.
- It can also cause hypertension. Chronic kidney disease and anemia are among the most frequent comorbid conditions in people with heart failure.
- Individuals with an underlying cardiac condition tolerate anemia poorly. It should ideally be detected and treated early before progressing to heart failure.
