Effects of beta-blockers in an 18-year old thalassemia patient with severe cardiac siderosis

Abstract

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