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[Angina pectoris in leiomyoma]
Insights
Anemia can mimic coronary heart disease symptoms. Correcting anemia resolved chest pain in a patient, highlighting the need to rule out anemia before invasive cardiac procedures.
Area of Science:
- Cardiology
- Gastroenterology
- Hematology
Background:
- Coronary heart disease (CHD) presents with chest pain, often necessitating invasive diagnostics.
- Anemia, characterized by low hemoglobin and mean corpuscular volume, can present with similar symptoms.
Observation:
- A 72-year-old male with CHD risk factors (smoking, hypertension) exhibited angina symptoms.
- Laboratory tests revealed severe anemia (hemoglobin 79 g/l, MCV 63 fl) and low serum iron.
- Gastrointestinal investigation identified an intestinal leiomyoma as the cause of chronic anemia.
Findings:
- Surgical removal of the leiomyoma and subsequent hemoglobin normalization completely resolved the patient's angina symptoms.
- Coronary angiography showed significant right coronary artery stenosis but non-significant left coronary artery stenosis.
Implications:
- Anemia should be considered and investigated as a potential sole cause of angina pectoris.
- Evaluating and treating anemia is crucial before definitive cardiac interventions in patients with suspected CHD.
Abstract:
A 72-year-old patient presented himself with typical symptoms of coronary heart disease and was scheduled for invasive diagnostic procedures. Cardiac risk factors were smoking and arterial hypertension. The physical examination was inconspicious. In the laborchemistry a hemoglobin of 79 g/l with a mean corpuscular volume of 63 fl and a mean corpuscular hemoglobin of 20 pg was conspicuous. The serum iron was with 42 micrograms/dl in the lower norm. Transferrin, bili-rubin and lactate dehydrogenase were normal. Then in the gastrointestinal investigations he was diagnosed with a leiomyoma of the intestine that led to chronic anaemia and additionally to chest pain characteristic for angina pectoris. After the removal of the tumor and normalization of hemoglobin this patient was free from symptoms of the disease. The coronary angiography revealed a complex stenosis of the right coronary artery with collaterales and not significant stenosis both of the left coronary arteries. In patients with angina pectoris anaemia as the possible and only cause of angina ought to be verified. It is therefore necessary after normalization of hemoglobin and clarification of the cause for the anaemia to apply a test for coronary ischemia.