Protecting your heart

Heart problems from iron were once the leading cause of death in thalassaemia — and they’re now largely preventable with steady chelation and monitoring. Iron can build up silently in the heart muscle for years before any symptoms appear.

The heart can be affected in a few ways: iron weakening the pumping muscle (which can lead to heart failure), irregular heartbeats (arrhythmias such as atrial fibrillation, or slow rhythms/heart block), and, less often, raised pressure in the lung arteries (pulmonary hypertension). Regular checks — an echocardiogram plus the cardiac T2* MRI — watch for all of these.

The cardiac T2* MRI is the key tool: it catches heart iron early, while it’s still reversible by intensifying chelation. Deferoxamine and deferiprone (often combined) are especially good at clearing heart iron. Reassuringly, with regular chelation, heart failure is now rare — and when it does occur, iron-related heart weakness can often be reversed with intensive continuous deferoxamine if caught early, though the T2* takes years to fully recover.

Get urgent help for new breathlessness, chest tightness, a racing or irregular heartbeat, or swollen ankles.