Introduction: Patients with transfusion dependent Thalassemia have cardiac complications as a result of chronic high output state and the iron overload of the myocardium. Gradually, a high output state leads to high output heart failure. This is the leading cause of mortality among thalassemic patients.
Materials and methods: 18-year old Thalassemia major patient who was regularly receiving hemotransfusions since early childhood was admitted to the hospital. By using T2* cardiovascular magnetic resonance, severe myocardial iron overload 7, 02 was noted. Since January 2017, the patient has been receiving regular check-ups due to the complaints of weakness and dyspnea. Electrocardiography performed after the patient received hemotransfusion showed sinus rhythm with the heart rate (HR) of 95 beats per minute (b.p.m.). Echocardiography showed a reduced ejection fraction (EF) 45, 6% and in tissue Doppler imaging reduced myocardial velocities were examined. Patient started treatment with a beta-blocker, bisoprolol 2,5mg oral per day (o.d.).
Results: After bisoprolol 2,5mg o.d. treatment for a month and a half, a follow-up echocardiography was performed. On echocardiography examination, a significant improvement in contractile function, EF 58, 5%, HR 73b.p.m. was observed. Echocardiography performed seven months later showed EF of 60% and an increase in the myocardial systolic velocity (Sm) compared with the first echocardiographic examination. The complaints were decreased to a minimum.
Conclusion: Beta-blockers are used in the standard treatment for the patients with heart failure who have reduced ejection fraction. However, beta-blockers should be used with caution for patients with thalassemia since these patients tend to have low blood pressure in nature. Significant improvement on patients` severe myocardial siderosis and low myocardial contractile function of the left ventricle was achieved after starting the treatment with beta-blockers. The symptoms of heart failure due to the severe myocardial iron deposition due to hemotransfusions was successfully managed with beta-blockers.
