|Dyspnea is a very common complaint for which patients seek medical care. In majority of the patients their dyspnea can be attributed to one of the following causes asthma, pneumonia, chronic obstructive pulmonary disease, myocardial dysfunction, pulmonary embolus and deconditioning. Our case here presents an etiology representing a subtle cause of myocardial dysfunction. The fundamental factor in determining this patientâs cause of dyspnea is severe iron deficiency, which in the USA is mostly secondary to occult blood loss. But more and more studies now are pointing towards celiac disease as a frequent cause of iron deficiency. One study reports that 12% of 93 patients with iron deficiency anemia had findings compatible with celiac disease on small bowel biopsy. Another study reports the incidence as 6% (85 patients) and the incidence increases to 20% in the subset of anemic patients that are unresponsive to iron therapy. It remains unclear whether a component of blood loss contributes to iron deficiency in celiac disease.