Full text loading...
Therapeutic Research
Abstract
We experienced a case of 80s –year–old woman with hypertrophic obstructive cardiomyopathy complicated with anemia. Her examinations revealed a left ventricular outflow tract –pressure gradient(LVOT–PG)of 224 mmHg and normocytic and normochromic anemia with a hemoglobin level of 6.7 g/dL. Metabolism of iron showed a pattern of iron deficiency. However, the number of fragmented red cells was very large which was 11% of a count of red cells and a haptoglobin level was very low(3 mg/dL). These data showed a cause of anemia was both iron deficiency and a red cell fragmentation syndrome, that is, mechanical intravascular hemolysis due to LVOT obstruction. She was not able to be treated with either cibenzoline succinate or atenolol because of dizziness and bradycardia. We therefore tried to DDD pacing therapy for relief from LVOT obstruction. LVOT–PG was decreased to 140 mmHg after the therapy. Moreover, administration of metoprolol tartrate up to 40 mg/day resulted in decrease of LVOT–PG to 21 mmHg, finally. Systolic anterior motion of mitral valve leaflet was disappeared and mitral regurgitation was diminished concomitantly, and a NYHA functional class was improved from III to II and a hemoglobin level was gradually improved up to 12.3 g/dL.
Data & Media loading...