Folic acid deficiency in congestive heart failure.

The purpose of this report is to indicate that deficiency of folic acid occurs with notable frequency in patients with past or immediate congestive heart failure. The study described was stimulated by the clinical examination of two anaemic patients with heart disease whose bone-marrows showed morphological features consistent with a lack of this haematinic. There were several additional reasons, however, to think that a project organized to pursue this initial impression was potentially worth while. First, patients with heart disease and congestive failure are anorexic, eat sparingly, and receive sodium-restricted diets lacking foods in which folic acid is found (Herbert, 1962). In addition, many such patients have abnormalities of liver function (Richman, Delman, and Grob, 1961), related to chronic passive congestion, which leads to this organ's inability to store active metabolites of folic acid (Cherrick et al., 1965). Finally, gastro- intestinal malabsorption (Valberg et al., 1965) associated with congestive failure could further contribute to folic acid deficiency in these patients.