Therapeutic phlebotomy should be started in men with serum ferritin levels of 300 Ојg/l or more and in women with serum ferritin levels of 200 Ојg/l or more. Therapeutic phlebotomy is the therapy of choice in nonanemic patients with cardiac hemochromatosis.

Cardiac magnetic resonance imaging is superior to other diagnostic tests since it can quantitatively assess myocardial iron load. If these tests are consistent with iron overload, further noninvasive and histologic confirmation is indicated to confirm organ involvement with iron overload. Screening for systemic iron overload with serum ferritin and transferin saturation should be performed. Cardiac hemochromatosis should be considered in any patient with unexplained heart failure. Deposition of iron may occur in the entire cardiac conduction system, especially the atrioventricular node. Cardiac hemochromatosis is characterized by a dilated cardiomyopathy with dilated ventricles, reduced ejection fraction, and reduced fractional shortening. Once heart failure develops, there is rapid deterioration. Patients may be asymptomatic early in the disease. Iron-overload syndromes may be hereditary or acquired.

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