Introduction: Iron deficiency and anemia are recognized as comorbid care that influences the negative evolution and prognosis of the patient with heart failure. Anemia is associated with decreased aerobic performance, expressing the clinic through physical asthenia and reducing exercise capacity. The cause of anemia should remain permanently during the search, but the multitude of patients with heart failure cannot be detected or a specific cause.

Methods: We present the case of a 75-year-old patient with a history of streptococcal tonsillitis in childhood, diagnosed at the age of 45 with the rheumatic mitro-aortic disease, having surgery at the age of 53 when the metal prosthesis was performed in the aortic position, mitral valvuloplasty and tricuspid annuloplasty, known with atrial fibrillation from the age of 53, with progressive evolution to dilated cardiomyopathy and diabetic heart failure (under treatment with biguanides), which is hospitalized in severe condition showing signs and symptoms of global cardiac.

Results: T he performed investigations confirmed the severity of the valve lesions, with important disorders of echocardiographic dynamics, but with the normal functioning of the aortic valve prosthesis, coexisting with severe cardiac stasis, which self-limits the mobilization. Dynamic electrocardiographic monitoring showed a medium to slow atrial fibrillation with polymorphic ventricular extrasystoles and transient periods of junctional rhythm with a frequency between 50 and 80 beats/minute. Biologically, normocytic hypo-chromic anemia (Hb= 8.7g/dl), hyposideremia (serum iron= 18 mg/dl), a low value of ferritin (ferritin= 15 ng/ ml), hypoproteinemia, hypercholesterolemia, dyselec-trolytemia, nitrogen retention syndrome are detected, increased NT proBNP (2345 pg/ml). Under sustained and complex treatment, the improvement of cardiac decompensation and hematological profile was obtained, as well as the increase in exercise tolerance.

Conclusions: Anemic patients have severe symptoms of heart failure, poor functional status, high risk of ho-spitalization for symptoms due to heart failure and reduced survival. The 2016 ESC Heart Failure Guide recommends investigating the iron status and correcting iron deficiency regardless of the association of anemia, with numerous studies attesting to increased exercise tolerance and improved quality of life for patients with heart failure.