Severe Anemia presenting as Heart Failure with Preserved Ejection Fraction

In chronic anemia, the reduced oxygen-carrying capacity of hemoglobin is typically offset by an elevated cardiac output. Patients with chronic severe anemia but no other cardiovascular disease rarely develop symptoms of congestive heart failure, a condition known as non-cardiac circulatory congestion. Severe anemia can induce a hyperdynamic circulation and chronic volume overload, potentially resulting in significant alterations to echocardiographic parameters, especially global left ventricular strain. This case describes a 16-year-old male patient with severe anemia who developed congestive heart failure, particularly pulmonary congestion. A comprehensive clinical examination, along with pathological, radiological, ECG, and two-dimensional echocardiographic investigations, was performed, and their distinctive features are presented herein. This study focuses on severe anemia, high output heart failure, and the assessment of left ventricular dysfunction using 2D strain imaging and global longitudinal strain via echocardiography.