Case Studies

Iron Deficiency Anemia and Ventricular Tachycardia

Iron Deficiency Anemia

Case Study 1:

A 17 year old female presents with chronic fatigue and decreasing athletic performance. Her mile, 2 mile, and 5k times are steadily increasing, even as training continues. Whereas she used to be able to run 10+ miles without much issue, it now takes much more effort for her to complete anything above 6 miles. When she runs long and slow, she often feels as if she has weights attached to her feet and it seems as if she places extensive effort just to put one foot in front of the other. When she does speed work, her heart rate skyrockets and she becomes very short of breath in just a small amount of time, definitely a much shorter time than previously. Her coach has even remarked that she appears pale during races. Additionally, she's experienced many more respiratory issues, even during the summer, than is normal for her, and has had frequent headaches.


Upon description of her symptoms, she was referred to a hospital for a hematocrit test to check her iron and red blood cell levels, with the symptoms she described being very consistent with iron-deficiency anemia. It appears as if she may be suffering from sports anemia, or even hemolysis, where extreme activity actually causes the destruction of red blood cells.


Here blood tests indicated that her blood iron levels were less than 12 ng/mL and her serum ferritin (stored version of iron) were less than 20 ng/mL, leading to her final diagnosis of stage 2 iron deficiency anemia. This is characterized by symptomatically low iron and ferritin levels, as well as decreased red blood cell count.


As treatment, she was told to her increase her iron-consumption with more iron-rich foods, as well as given a supplement to help aid the process. In order to help with iron-storage and processing, she was told to include foods and drinks high in vitamin C and low in calcium. This should, over time, increase her stored and blood iron levels, leading to more efficient hemoglobin production and a higher red blood cell count. After iron levels are restored, athletic performance should be on the rise and energy should increase as well. These levels, however, do need to be monitored and maintained, especially if endurance athletic activity persists.

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Non-Sustained Ventricular Tachycardia

Case Study 2:


A 29 year old male presented with intermittent chest pain and tightness, dizziness, lightheadedness, and difficult breathing. He described these symptoms as occurring in clusters, most prominent during exercise and periods of extreme stress or emotional discomfort. In his words, he felt as if he'd "hit a brick wall" and had all the air knocked out of him. Some days were worse than others. Sometimes, he felt as if his heart was fluttering or beating out of his chest. Ultimately, during these episodes, he felt incapacitated and couldn't continue until the symptoms disappeared and he felt as if he had returned back to normal function.


After assessing these symptoms, he was first scheduled for an MRI, to rule out any structural abnormality in the heart. These scans came up clean. Next, since these periods of symptoms came at such inconsistent intervals, he was given a heart rate monitor to wear for 24 hours to track any irregularities. Upon analysis of this version of an EKG, it was noted that at certain times, there were 3 ventricular beats for every 1 atrial beat, only occurring with a very rapid heart rate, resulting in a very frantic-looking EKG. In order to continue observing the parameters of this heart malfunction, this man was ordered to take a stress test, where his heart rate was monitored as he ran on a treadmill. Just shortly after beginning to move at a heightened pace, his heart rate skyrocketed way past his theoretical max, going all the way up to 230/min before he was ordered to stop. However, he reported feeling as if he was exerting a normal amount of effort, and his heart rate restored its normal pace after a short time. This erratic heart behavior led to his diagnosis of Non-Sustained Ventricular Tachycardia, which corrected itself, and was most likely linked to an unhealthy lifestyle.


He was given oral medication to help keep his heart rate within healthy limits (he reported at a later time that his resting heart rate would decrease to about 35/min during law school lectures, leaving him feeling sedated and extremely 'out of it'). This medication made sure his heart rate didn't get so high during exercise or so low during periods of rest. He was advised that if he wasn't careful, he could digress into ventricular fibrillation, in which case immediate medical attention is needed to avoid death. Additionally, he was advised to wear a heart rate monitor while running to observe heart function, just as a precaution, and to note a hopeful increase in regularity as time progressed. However, if he took his medication and tried to better his lifestyle, his prognosis appeared very good.


Now, 10 years, a law school degree, and 6 or 7 marathons later, he hardly ever experiences these arrhythmias. The only time he would feel those same initial symptoms were during the last few miles of the 26.2 mile races or in times of extreme stress (like before the bar exam). He is at least 50 pounds lighter than he was at the time of diagnosis, and is in much better condition, health-wise. He has even stopped taking his medication because of how infrequent his arrhythmias have become and how much more maintained his heart rate seems to be. While running up hills or doing other very strenuous activities, his heart rate still gets up to 195/min, but he says its nothing he doesn't feel his body can handle. Ultimately, his prognosis is excellent at this time, and he has really rebounded from his condition.

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Sources

"Iron and Iron Deficiency." Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 23 Feb. 2011. Web. 09 Mar. 2015. <http://www.cdc.gov/nutrition/everyone/basics/vitamins/iron.html>.


Krucik, George, MD. "Ventricular Tachycardia." Healthline. Healthline Networks, Inc, 23 July 2012. Web. 10 Mar. 2015. <http://www.healthline.com/health/ventricular-tachycardia#Overview1>.


Mueller, Kimberly J. "When Fatigue Slows You Down: Iron-deficiency Anemia." ACTIVE.com. Active Network, LLC, n.d. Web. 10 Mar. 2015. <http://www.active.com/articles/when-fatigue-slows-you-down-iron-deficiency-anemia>.