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Cardiac changes in anorexia nervosa

Published online by Cambridge University Press:  14 January 2016

Michael A. Spaulding-Barclay ,
Jessica Stern  and
Philip S. Mehler
Michael A. Spaulding-Barclay
Affiliation:
Department of Psychiatry, Eating Recovery Center, Denver, Colorado, United States of America Department of Medicine, Eating Recovery Center, Denver, Colorado, United States of America
Jessica Stern
Affiliation:
Department of Psychiatry, Eating Recovery Center, Denver, Colorado, United States of America
Philip S. Mehler*
Affiliation:
Department of Psychiatry, Eating Recovery Center, Denver, Colorado, United States of America Department of Medicine, Eating Recovery Center and Denver Health, Denver, Colorado, United States of America
*
Correspondence to: P. S. Mehler, MD, FAED, FACP, c/o Denver Health, 777 Bannock Street, MC4000, Denver, CO 80204, United States of America. Tel: 303 602 4972; Fax: 303-602-4975; E-mail: [email protected]
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Abstract

Introduction

Anorexia nervosa is an eating disorder, which is associated with many different medical complications as a result of the weight loss and malnutrition that characterise this illness. It has the highest mortality rate of any psychiatric disorder. A large portion of deaths are attributable to the cardiac abnormalities that ensue as a result of the malnutrition associated with anorexia nervosa. In this review, the cardiac complications of anorexia nervosa will be discussed.

Methods

A comprehensive literature review on cardiac changes in anorexia nervosa was carried out.

Results

There are structural, functional, and rhythm-type changes that occur in patients with anorexia nervosa. These become progressively significant as ongoing weight loss occurs.

Conclusion

Cardiac changes are inherent to anorexia nervosa and they become more life-threatening and serious as the anorexia nervosa becomes increasingly severe. Weight restoration and attention to these cardiac changes are crucial for a successful treatment outcome.

Keywords

Anorexia nervosacardiovascularbradycardiaventricularmalnutrition
Type
Review Articles
Information
Cardiology in the Young , Volume 26 , Issue 4 , April 2016 , pp. 623 - 628
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Copyright
© Cambridge University Press 2016 

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References

1. Arcelus, J, Mitchell, AJ, Wales, J, Nielson, S. Mortality rates in patients with anorexia nervosa and other eating disorders. A meta-analysis of 36 studies. Arch Gen Psychiatry 2011; 68: 724–731.Google Scholar
2. De Simeone, G, Scalfi, L, Galderisi, M, et al. Cardiac abnormalities in young women with anorexia nervosa. Br Heart J 1994; 71: 287–292.CrossRefGoogle Scholar
3. Sharp, CW, Freeman, CPL. The medical complication of anorexia nervosa. Br J Psychiatry 1993; 162: 452–462.CrossRefGoogle ScholarPubMed
4. Cooke, RA, Chambers, JB, Singh, R, et al. QT interval in anorexia nervosa. Br Heart J 1994; 72: 69–73.CrossRefGoogle ScholarPubMed
5. Goldberg, SJ, Comerci, GD, Feldman, L. Cardiac output and regional myocardial contraction in anorexia nervosa. J Adolesc Health Care 1988; 9: 15–21.CrossRefGoogle ScholarPubMed
6. Isner, JM, Roberts, WC, Heymsfield, SB, Yager, J. Anorexia nervosa and sudden death. Ann Intern Med 1985; 102: 49–52.Google Scholar
7. Neumarker, KJ. Mortality and sudden death in anorexia nervosa. Int J Eat Disord 1997; 21: 205–212.3.0.CO;2-O>CrossRefGoogle ScholarPubMed
8. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th edn. American Psychiatric Association, Washington, DC, 2013.Google Scholar
9. Pinhas, L, Morris, A, Crosby, RD, Katzman, DK. Incidence and age-specific presentation of restrictive eating disorders in children: a Canadian Surveillance Program study. Arch Pediatr Adolesc Med 2011; 165: 895–899.CrossRefGoogle ScholarPubMed
10. Couturier, J, Lock, J, Forsberg, S, Vanderheyden, D, Yen, HL. The addition of a parent and clinician component to the eating disorder examination for children and adolescents. Int J Eat Disord 2007; 40: 472–475.Google Scholar
11. Workgroup for Classification of Eating Disorders in Children and Adolescents. Classification of child and adolescent eating disturbances. Int J Eat Disord 2007; 40: 5117–5122.Google Scholar
12. Hudson, JI, Hiripi, E, Pope, HG Jr, Kessler, RC. The prevalence and correlates of eating disorders in the National Comorbidity Survey replication. Biol Psychiatry 2007; 61: 348–358.Google Scholar
13. Sigel, E. Eating disorders. Adolesc Med State Art Rev 2008; 19: 547–572.Google ScholarPubMed
14. Kaye, WH, Wierenga, CE, Knatz, S. Temperament-based treatment for anorexia nervosa. Eur Eat Disord Rev 2015; 23: 12–18.CrossRefGoogle ScholarPubMed
15. Lesinskiene, S, Barkus, A, Ranceva, N, Dembinskas, A. A meta-analysis of heart rate and QT interval alteration in anorexia nervosa. World J Biol Psychiatry 2008; 9: 86–91.CrossRefGoogle ScholarPubMed
16. Silvetti, MS, Magnani, M, Santilli, A, et al. The heart of anorexic adolescents. G Ital Cardiol 1998; 28: 131–139.Google ScholarPubMed
17. Conri, C, Roudaut, R, Ducloux, G, Fleury, B, Moreau, F. Echocardiography in anorexia nervosa. Presse Med 1989; 18: 806–808.Google Scholar
18. Cooke, RA, Chambers, JB. Anorexia nervosa and the heart. Br J Hosp Med 1995; 54: 313–317.Google ScholarPubMed
19. Franzoni, F, Galetta, F, Cupisti, A, Rolla, M, Santoro, G, Pentimone, F. Ultrasonic tissue characterization of the myocardium in anorexia nervosa. Acta Paediatr 2003; 92: 297–300.CrossRefGoogle ScholarPubMed
20. De Simone, G, Scalfi, L, Galderisi, M, et al. Cardiac abnormalities in young women with anorexia nervosa. Br Heart J 1994; 71: 287–292.Google Scholar
21. Eidem, BW, Cetta, F, Webb, JL, Graham, LC, Jay, MS. Early detection of cardiac dysfunction: use of the myocardial performance index in patients with anorexia nervosa. J Adolesc Health 2001; 29: 267–270.Google Scholar
22. Mizuno, R, Fujimoto, S, Kimura, Y, Yoshioka, A, Nakano, H, Dohi, K. Anorexia nervosa with left atrial failure. Intern Med 1998; 37: 857–860.Google Scholar
23. Galetta, F, Franzoni, F, Prattichizzo, F, et al. Heart rate variability and left ventricular diastolic function in anorexia nervosa. J Adolesc Health 2003; 32: 416–421.Google Scholar
24. Moodie, DS, Salcedo, E. Cardiac function in adolescents and young adults with anorexia nervosa. J Adolesc Health Care 1983; 4: 9–14.CrossRefGoogle Scholar
25. Gottdiener, JS, Gross, HA, Henry, WL, Borer, JS, Ebert, MH. Effects of self-induced starvation on cardiac size and function in anorexia nervosa. Circulation 1978; 58: 425–433.Google Scholar
26. Kalager, T, Brubakk, O, Bassoe, HH. Cardiac performance in patients with anorexia nervosa. Circulation 1978; 583: 425–433.Google Scholar
27. Kahn, D, Halls, J, Bianco, JA, Perlman, SB. Radionuclide ventriculography in severely underweight anorexia nervosa patients before and during refeeding therapy. J Adolesc Health 1991; 12: 301–306.Google Scholar
28. Meyers, DG, Starke, H, Pearson, PH, Wilken, MK. Mitral valve prolapse in anorexia nervosa. Ann Intern Med 1986; 105: 384–386.CrossRefGoogle ScholarPubMed
29. Kastner, S, Salbach-Andrae, H, Renneberg, B, et al. Echocardiographic findings in adolescents with anorexia nervosa at beginning of treatment and after weight recovery. Eur Child Adolesc Psychiatry 2012; 21: 15–21.CrossRefGoogle ScholarPubMed
30. Casiero, D, Frishman, WH. Cardiovascular complications of eating disorders. Cardiol Rev 2006; 14: 227–231.CrossRefGoogle ScholarPubMed
31. Romano, C, Chinali, M, Pasanisi, F, et al. Reduced hemodynamic load and cardiac hypotrophy in patients with anorexia nervosa. Am J Clin Nutr 2003; 77: 308–312.CrossRefGoogle ScholarPubMed
32. Vazquez, M, Olivares, JL, Fleta, J, et al. Cardiac disorders in young women with anorexia nervosa. Rev Esp Cardiol 2003; 56: 669–673.Google Scholar
33. Oflaz, S, Yucel, B, Oz, F, et al. Assessment of myocardial damage by cardiac MRI in patients with anorexia nervosa. Int J Eat Disord 2013; 46 (8): 862–866.CrossRefGoogle ScholarPubMed
34. St. John Sutton, MG, Plappert, T, Crosby, L, Douglas, P, Mullen, J, Reichek, N. Effects of reduced left ventricular mass on chamber architecture, load, and function: a study of anorexia nervosa. Circulation 1985; 72: 991–1000.CrossRefGoogle ScholarPubMed
35. Olivares, JL, Vazquez, M, Fleta, J, et al. Cardiac findings in adolescents with anorexia nervosa at diagnosis and after weight restoration. Eur J Pediatr 2005; 164: 383–386.Google Scholar
36. Petretta, M, Banaduce, D, Scalfi, L, et al. Heart rate variability as a measure of autonomic nervous system function in anorexia nervosa. Clin Cardiol 1997; 20: 219–224.Google Scholar
37. Galetta, F, Franzoni, F, Cupisti, A, et al. QT interval dispersion in young women with anorexia nervosa. J Pediatr 2002; 140: 456–460.Google Scholar
38. Carlomagno, G, Mercurio, V, Ruvolo, A, et al. Endocrine alterations are the main determinants of cardiac remodeling in restrictive anorexia nervosa. Int Schol Res Net 2011; 2011: 171460.Google ScholarPubMed
39. Estour, B, Germain, N, Diconne, E, et al. Hormonal profile heterogeneity and short-term physical risk in restrictive anorexia nervosa. J Clin Endocrinol Metab 2010; 95: 2203–2210.Google Scholar
40. Mont, L, Castro, J, Herreros, B, et al. Reversibility of cardiac abnormalities in adolescents with anorexia nervosa after weight recovery. J Am Acad Child Adolesc Psychiatry 2003; 42: 808–813.Google Scholar
41. Hill, K, Bucuvalas, J, McClaine, C, et al. Pilot study of growth hormone administration during the refeeding of malnourished anorexia nervosa patients. J Child Adolesc Psychopharmacol 2000; 10: 3–8.CrossRefGoogle ScholarPubMed
42. Misra, M, McGrane, J, Miller, KK, et al. Effects of rhIGR-1 administration on surrogate markers of bone turnover in adolescents with anorexia nervosa. Bone 2009; 45: 493–498.Google Scholar
43. Grinspoon, S, Miller, K, Herzog, D, Clemmons, D, Klibanski, A. Effects of recombinant human insulin-like growth factor (IGF-1) and estrogen administration on IGF-1, IGF binding protein (IGFBP)-2, and IGFBP-3 in anorexia nervosa: a randomized-controlled study. J Clin Endocrinol Metab 2003; 88: 1142–1149.Google Scholar
44. Brady, JA, Rock, CL, Horneffer, MR. Thiamin status, diuretic medications, and the management of congestive heart failure. J Am Diet Assoc 1995; 95: 541–544.Google Scholar
45. Levander, OA. Selenium requirements as discussed in the 1996 joint FAO/IAEA/WHO expert consultation on trace elements in human nutrition. Biomed Environ Sci 1997; 10: 214–219.Google ScholarPubMed
46. Fonseca, V, Havard, CW. Electrolyte disturbances and cardiac failure with hypomagnesaemia in anorexia nervosa. Br Med J 1985; 291: 1680–1682.Google Scholar
47. Davidson, A, Anisman, PC, Eshaghpour, E. Heart failure secondary to hypomagnesemia in anorexia nervosa. Pediatr Cardiol 1992; 13: 241–242.CrossRefGoogle ScholarPubMed
48. Winston, AP, Jamieson, CP, Madira, W, Gatward, NM, Palmer, RL. Prevalence of thiamin deficiency in anorexia nervosa. Int J Eat Disord 2000; 28: 451–454.Google Scholar
49. Cariem, AK, Lemmer, ER, Adams, MG, Winter, TA, O’Keefe, SJ. Severe hypophosphatemia in anorexia nervosa. Postgrad Med J 1994; 70: 825–827.Google Scholar
50. Birmingham, CL, Alothman, AF, Goldner, EM. Anorexia nervosa: refeeding and hypophosphatemia. Int J Eat Disord 1996; 20: 211–213.3.0.CO;2-5>CrossRefGoogle ScholarPubMed
51. Georges, B, Thissen, JP, Lambert, M. Severe hypophosphatemia in a patient with anorexia nervosa during enteral refeeding. Acta Clin Belg 2004; 59: 361–364.CrossRefGoogle Scholar
52. Friedman, EJ. Death from ipecac intoxication in a patient with anorexia nervosa. Am J Psychiatry 1984; 141: 702–703.Google Scholar
53. Brotman, MC, Forbath, N, Garfinkel, PE, Humphrey, JG. Myopathy due to ipecac syrup poisoning in a patient with anorexia nervosa. Can Med Assoc J 1981; 125: 453–454.Google Scholar
54. Romig, RA. Anorexia nervosa, ipecac, and sudden death. Ann Intern Med 1985; 103: 641.Google Scholar
55. Ho, PC, Dweik, R, Cohen, MC. Rapidly reversible cardiomyopathy associated with chronic ipecac ingestion. Clin Cardiol 1998; 21: 780–783.Google Scholar
56. Romig, RA. The potential toxicity of ipecac. Am J Psychiatry 1984; 141: 1639.Google ScholarPubMed
57. Hopf, NJ, Goebel, HH. Experimental emetine myopathy: enzyme histochemical, electron microscopic, and immunomorphological studies. Acta Neuropathol 1993; 85: 414–418.CrossRefGoogle ScholarPubMed
58. Halmi, KA. Physiology of anorexia nervosa and bulimia nervosa. In: Fairburn CG, Brownell KD, (eds). Eating Disorders and Obesity: A Comprehensive Handbook. Guilford Press, New York, 2002: 267–271.Google Scholar
59. Silber, TJ. Ipecac syrup abuse, morbidity, and mortality: isn’t it time to repeal its over-the-counter status? J Adolesc Health 2005; 37: 256–260.CrossRefGoogle ScholarPubMed
60. Birmingham, CL, Gritzner, S. Heart failure in anorexia nervosa: case report and review of the literature. Eat Weight Disord 2007; 12: e7–e10.Google Scholar
61. Ohwada, R, Hotta, M, Kimura, H, et al. Ampulla cardiomyopathy after hypoglycemia in three young female patients with anorexia nervosa. Intern Med 2005; 44: 228–233.CrossRefGoogle ScholarPubMed
62. Bonnemeier, H, Mall, G, Wiedang, UK. Sudden cardiac death due to catecholamine cardiomyopathy in anorexia nervosa. Resuscitation 2006; 68: 9–10.Google Scholar
63. Lee, SR, Ko, TH, Kim, HK, et al. Influence of starvation on heart contractility and corticosterone level in rats. Pflugers Arch 2015; 467: 2351–2360. Google Scholar
64. Roche, F, Barthelemy, JC, Garet, M, et al. Chronotropic incompetence to exercise separates low body weight from established anorexia nervosa. Clin Physiol Funct Imaging 2004; 24: 270–275.Google Scholar
65. Katzman, DK. Medical complications in adolescents with anorexia nervosa: a review of the literature. Int J Eat Disord 2005; 37 (Suppl): S52–S59.Google Scholar
66. Swenne, I, Larson, PT. Heart risk associated with weight loss in anorexia nervosa and eating disorders: risk factors for QTc interval prolongation and dispersion. Acta Paediatr 1999; 88: 304–309.CrossRefGoogle ScholarPubMed
67. Roche, F, Barthelemy, JC, Mayaud, N, et al. Refeeding normalizes the QT rate dependence of female anorexic patients. Am J Cardiol 2005; 95: 277–280.Google Scholar
68. Ulger, Z, Gurses, D, Ozyurek, AR, Arikan, C, Levent, E, Aydogdu, S. Follow-up of cardiac abnormalities in female adolescents with anorexia nervosa after refeeding. Acta Cardiol 2006; 61: 43–49.Google Scholar
69. Johnson, GL, Humphries, LL, Shirley, PB, Mazzoleni, A, Noonan, JA. Mitral valve prolapse in patients with anorexia nervosa and bulimia. Arch Intern Med 1986; 146: 1525–1529.Google Scholar
70. Avierinos, JF, Gersh, BJ, Dphil, Ch, et al. Natural history of asymptomatic mitral valve prolapse in the community. Circulation 2002; 106: 1355–1361.Google Scholar
71. Park, MK. The Pediatric Cardiology Handbook, 2nd edn. Mosby-Year Book, Inc., St. Louis, MO, 1997.Google Scholar
72. Mehler, PS, Andersen, AE. Eating Disorders: A Guide to Medical Care and Complications, 2nd edn. The Johns Hopkins University Press, Baltimore, MD, 2010.Google Scholar
73. Frolich, J, von Gontard, A, Lehmkuhl, G, et al. Pericardial effusions in anorexia nervosa. Eur Child Adolesc Psychiatry 2001; 10: 54–57.Google Scholar
74. Ramaciotti, CE, Coli, E, Biadi, O, et al. Silent pericardial effusion in a sample of anorexic patients. Eat Weight Disord 2003; 8: 68–71.Google Scholar
75. Docx, M, Gewillig, M, Simons, A, et al. Pericardial effusions in adolescent girls with anorexia nervosa: clinical course and risk factors. Eat Disord 2010; 18: 218–225.CrossRefGoogle ScholarPubMed
76. Polli, N, Blengino, S, Moro, M, et al. Pericardial effusion requiring pericardiocentesis in a girl with anorexia nervosa. Int J Eat Disord 2006; 39: 609–611.CrossRefGoogle Scholar
77. Kircher, JN, Park, MH, Cheezum, MK, et al. Cardiac tamponade in association with anorexia nervosa: a case report and review of the literature. Cardiol J 2012; 19: 635–638.Google Scholar
78. Cho, YK, Yang, SJ, Ma, JS. Pericardial effusion in three cases of anorexia nervosa. Korean J Pediatr 2008; 51: 209–213.Google Scholar
79. Slivka, M, Buckelew, S, Shafer, M-A, Mosicki, A-B, Garber, A. Cardiac findings among adolescents on first hospital admission for medical complications of anorexia nervosa. J Adolesc Health 2009; 44 (Suppl 1): S4–S5.Google Scholar
80. Inagaki, T, Yamamoto, M, Tsubouchi, K, et al. Echocardiographic investigation of pericardial effusion in a case of anorexia nervosa. Int J Eat Disord 2003; 33: 364–366.Google Scholar
81. Grover, CA, Robin, JK, Gharahbaghian, L. Anorexia nervosa: as case report of a teenager presenting with bradycardia, general fatigue, and weakness. Pediatr Emerg Care 2012; 28: 174–177.CrossRefGoogle ScholarPubMed
82. Kollai, M, Bonyhay, I, Jokkel, G, Szonyi, L. Cardiac vagal hyperactivity in adolescent anorexia-nervosa. Eur Heart J 1994; 15: 1113–1118.Google Scholar
83. Bar, KJ, Boettger, S, Wagner, G, et al. Changes of pain perception, autonomic function, and endocrine parameters during treatment of anorectic adolescents. J Am Acad Child Adolesc Psychiatry 2006; 45: 1068–1076.Google Scholar
84. Habil, MH, Loke, KH. Sinus bradycardia in anorexia nervosa – a case report. Med J Malaysia 1990; 45: 177–178.Google Scholar
85. Kossaify, A. Management of sinus node dysfunction with junctional escape rhythm in a case of anorexia nervosa. Turk Kardiyol Dern Ars 2010; 38: 486–488.Google Scholar
86. Krantz, MJ, Gaudiani, JL, Johnson, VW, Mehler, PS. Exercise electrocardiography extinguishes persistent junctional rhythm in a patient with severe anorexia nervosa. Cardiology. 2011; 120: 217–220.Google Scholar
87. Krantz, MJ, Mehler, PS. Resting tachycardia, a warning sign in anorexia nervosa: case report. BMC Cardiovasc Disord 2004; 4: 10.Google Scholar
88. Benarroch, EE. Postural tachycardia syndrome: a heterogeneous and multifactorial disorder. Mayo Clin Proc 2012; 87: 1214–1225.Google Scholar
89. Docx, M, Simons, A, Ramet, J, Weyler, J, Thues, C, Mertens, L. Predictors of diminished corrected left ventricular mass index in female anorexic adolescents. Anaesthesiol Intensive Ther 2014; 46: 137.Google Scholar
90. Krantz, MJ, Donahoo, WT, Melanson, EL, Mehler, PS. QT interval dispersion and resting metabolic rate in chronic anorexia nervosa. Int J Eat Disord 2005; 37: 166–170.Google Scholar
91. Krantz, MJ, Sabel, AL, Sagar, U, et al. Factors influencing QT prolongation in patients hospitalized with severe anorexia nervosa. Gen Hosp Psychiatry 2012; 34: 173–177.CrossRefGoogle ScholarPubMed
92. Lamzabi, I, Syed, S, Reddy, VB, Jain, R, Harbhajanka, A, Arunkumar, P. Myocardial changes in a patient with anorexia nervosa: a case report and review of literature. Am J Clin Pathol 2015; 143: 734–737.Google Scholar
93. Melanson, EL, Donahoo, WT, Krantz, MJ, Poirier, P, Mehler, PS. Resting and ambulatory heart rate variability in chronic anorexia nervosa. Am J Cardiol 2004; 94: 1217–1220.Google Scholar
94. Vaurs, C, Rollin, A, Berard, W, et al. QT intervals is not prolonged in patients with eating disorders. Int J Cardiol 2014; 177: 134–135.CrossRefGoogle Scholar
95. Facchini, M, Sala, L, Malfatto, G, Bragato, R, Redaelli, G, Invitti, C. Low-K+dependent QT prolongation and risk for ventricular arrhythmia in anorexia nervosa. Int J Cardiol 2006; 106: 170–176.Google Scholar
96. Drew, BJ, Ackerman, MJ, Funk, M, et al. Prevention of torsade de pointes in hospital settings: a scientific statement from the American Heart Association and the American College of Cardiology Foundation. Circulation. 2010; 121: 1047–1060.Google Scholar