How To Know The Signs Of Anemic Heart Failure

If you or a loved one has been diagnosed with anemia or heart failure, you may wonder what connection these two conditions have. While they may seem like separate issues, research has shown a significant relationship between anemia and heart failure.

Understanding this relationship can help you better manage your health and reduce your risk of complications. This blog post will explore the causes and symptoms of anemia and heart failure and how they are linked. Let's dive in!

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Signs and symptoms of anemic heart failure

Anemia is a condition that occurs when your body has a lower number of healthy red blood cells or hemoglobin levels. This iron-rich protein in red blood cells is responsible for carrying oxygen. When you have anemia, your body fails to get sufficient oxygen supply.

Anemia is linked to heart failure, a condition that makes it difficult for the heart to pump enough oxygenated blood to various organs. In simpler terms, anemic heart failure reduces the oxygen-carrying and delivery capacity of the circulation system.

As a result, anemia and heart failure have some common signs and symptoms, which may include:

  • Feeling tired and weak due to oxygen deficiency

  • Shortness of breath

  • Chest pain

  • Fast or irregular heartbeat

If you have anemia, you may also have some of the following additional signs and symptoms:

  • Pale skin

  • Cold hands and feet

  • Restless legs syndrome

  • Sore tongue

  • Dizziness

  • Headaches

Heart failure, on the other hand, may make you experience the following additional signs Fand symptoms:

  • Swelling around the ankles or legs

  • Dry cough or wheezing

  • Reduced ability to perform physical activities

  • Difficulty focusing

  • Swelling of the abdomen (ascites)

  • Frequent urge to urinate, especially during the night

  • Lack of appetite

  • Stomach upset, including feeling bloated or nausea

What is anemia?

Anemia is a condition that is characterized by a reduction in the number of healthy red blood cells. The Centers for Disease Control and Prevention shows that about three million Americans have anemia.¹

Several factors can cause anemia. Different types of anemia are classified according to their causes and include the following:

Iron-deficiency anemia

This form of anemia develops when your body does not have enough iron. It is the most common type of anemia. 

Iron deficiency can be caused by the following:

  • Inadequate iron in the diet

  • Inability to absorb iron

  • Blood loss

  • Medical conditions or medications that affect the utilization of your iron stores

Vitamin B12–deficiency anemia

When you have this type of anemia, your body cannot make enough red blood cells because you do not have enough vitamin B12, essential for synthesizing red blood cells in the bone marrow. This can happen due to a lack of vitamin B12 in your diet or a gut problem that interferes with absorption.

You can reduce your risk of getting this type of anemia by taking a diet rich in vitamin B12, eating fortified foods, and taking supplements if you are a vegan.

Hemolytic anemia²

If you have hemolytic anemia, it means your red blood cells are destroyed faster than they are replaced. This type of anemia can occur due to certain medical conditions, medications, or complications of blood transfusion.

Anemia can also be caused by a lack of production of red blood cells from the bone marrow due to a lack of stimulating hormones (erythropoietin) or issues affecting the bone marrow itself. 

This and iron-deficiency anemia are the most common types of anemia in individuals with heart failure.

Heart failure explained

Your heart is responsible for pumping oxygen-rich blood to other organs. This happens during the contraction of the heart muscles when the heart pushes blood into the blood vessels.

Heart failure is chronic and progressive conduction that inhibits the ability of the heart to pump oxygenated blood to all organs in your body.

When you have heart failure, your heart cannot pump blood to meet its oxygen demand. Since your heart uses its muscles to pump blood, heart failure would mean the muscles have become weak. To meet its workload, the heart may increase the muscle mass, enlarge, or increase its pumping rate. Your body may also respond by narrowing blood vessels to increase blood pressure.

Iron deficiency anemia and heart problems

Iron deficiency means you have less than the required level of iron. Iron is used by the body to make hemoglobin, which carries oxygen. If you have an iron deficiency, your body will not produce enough hemoglobin, which means your blood will have reduced oxygen-carrying capacity. 

The reduced oxygen-carrying capacity leads to anemia, which means your body cells and organs are not getting enough oxygen. Your heart has to work harder to compensate for the reduced oxygen-carrying capacity. The overtime work given to your heart leads to heart problems, including heart failure.  

Can anemia cause heart failure?

Research shows a high prevalence of anemia in people with heart failure. About 30% of people with stable heart failure suffer from anemia, and 70% of people hospitalized with heart failure have anemia. Hence, there is a strong association between heart failure and anemia, as the two conditions co-exist in many cases.³

Anemia can often be considered a complication of heart failure due to several interrelated factors that contribute to the development of anemia in people with heart failure, such as:

  • Reduction of synthesis of a hormone called erythropoietin (produced by the kidneys), which stimulates the bone marrow to produce red blood cells

  • Reduction in the response of the bone marrow to the available erythropoietin

  • Iron deficiency, or defective utilization of the available adequate iron

  • Systemic inflammation

However, anemia can also cause heart failure in certain situations, especially in the case of iron deficiency anemia, and if it becomes severe or left untreated for a long period. 

Insufficient oxygen in the body's organs due to anemia may cause your heart to overwork to compensate for the drop in blood oxygen levels. This can cause the left ventricle of the heart to malfunction after some time and the heart cells to start dying, eventually leading to heart failure.

How is heart failure diagnosed?

If your doctor orders a heart functional test, it means they want to assess the ability of your heart to meet its workload in the body. Functional tests can help your doctor detect challenges that could lead to heart failure. A functional test can also be used as a diagnostic tool for heart failure if you present symptoms of heart failure.

Common heart functional tests include:

  • Electrocardiogram (ECG), which reads your heart's electric pulses

  • Exercise stress test or treadmill test, which tests how well your heart works when you are active

  • Echocardiogram (ultrasound), which helps your doctor observe how well your heart pumps blood or identify any challenge with your blood vessels

How is anemia diagnosed?

If you present symptoms of anemia, your doctor will perform diagnostic tests before prescribing treatment. Your doctor will take blood samples and perform a laboratory blood test. 

A blood test measures the following:

  • Red blood cell levels. If the blood test shows that your red blood cells are lower than the required levels, you will likely have anemia.

  • Hemoglobin levels. If the blood test shows you have a lower hemoglobin level, you could have anemia.    

  • Hematocrit levels. Hematocrit measures the space red blood cells take in your blood. If the hematocrit levels are too low, it could indicate anemia.

  • Mean corpuscular volume (MCV) levels. This is done to measure the size of your red blood cells. A higher or lower level may be a sign of anemia.

Possible heart complications if you are anemic

Mild anemia may not have an impact on the heart. However, severe iron deficiency and anemia may lead to left ventricular (LV) dysfunction and overt heart failure. Anemia can also exacerbate heart failure. Heart failure patients with anemia are much more likely to be hospitalized and die than those without anemia.⁴

How to prevent heart failure if you are anemic

Early diagnosis and treatment of anemia are essential to prevent any negative impact on your heart. If you already have cardiovascular issues, including heart failure, early anemia treatment will halt this condition's rapid progression.

You must pay close attention to the symptoms of anemia, and if you notice any, consult with your doctor, who will run tests to make a diagnosis. 

There are several ways of treating anemia, depending on its cause. Increasing your iron intake may help treat the condition if you have iron deficiency anemia. Your doctor may also recommend an intravenous injection of iron. Increasing your vitamin B12 can also help if your anemia is caused by vitamin B12 deficiency.

If you are diagnosed with anemia and already have heart failure or chronic kidney disease that puts you at risk of heart failure, your doctor may additionally prescribe erythropoietin treatment to compensate for the potential deficiency and stimulate the bone marrow to produce more healthy red blood cells.

Ways to treat iron deficiency anemia

You can treat iron deficiency by increasing your iron intake. You can increase iron in your diet by taking iron-rich foods or supplements. If you are on an iron supplement, try to:

  • Avoid combining iron tablets with antacids

  • Take iron tablets on an empty stomach when possible

  • Combine your iron tablets with vitamin C supplements

Treating the underlying cause of iron deficiency may also help you reduce the risk of anemia. Your doctor can diagnose the cause of your iron deficiency and recommend treatment.

The lowdown

Studies have shown a link between anemia and heart failure. Heart failure can cause anemia, while anemia may also lead to heart failure or worsen it if left untreated. Early detection and treatment are important to reduce the risk of developing or worsening heart failure.

Frequently asked questions

Can anemia cause heart problems?

Yes, anemia is closely related to heart failure and can worsen heart problems. If you have anemia, the best thing is to seek treatment to reduce the risk of heart problems.

Can an iron deficiency cause heart failure?

Iron deficiency is the leading cause of anemia. An iron deficiency reduces the oxygen-carrying capacity of your blood, which, if severe or not treated for a long time, can lead to heart failure as your heart struggles to compensate for the reduced oxygen levels.

What is the association between anemia and heart failure?

Anemia and heart failure lead to reduced oxygen levels in your blood. Anemia is found in many people with heart failure and can be either a complication or a cause of heart failure.

  1. What is anemia? | National Heart, Lung, and Blood Institute

  2. Hemolytic anemia | National Heart, Lung, and Blood Institute

  3. Anemia and iron deficiency in heart failure (2018)

  4. (As above)

Other sources:

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