Bradycardia is a common finding in AN. Its existence in young adults, especially young females with weight loss, represents an ominous sign for cardiac sudden death.
IV ACCESS , U/E
HDU MONITORING
It was recommended that patients with AN who are admitted to the hospital with a HR of less than 35 bpm should have continuous monitoring. Medication such as inotropic drugs should be avoided and are contraindicated because of the possibility of additional potential ventricular arrhythmias
ECG (especially if bradycardic or any other CVS complication) Other cause for bradycardia (e.g. heart block), arrhythmia, check QTc time (measure using Bazett’s formulaa ), check electrolytes Prolonged QTc, heart rate <50 bpm, arrhythmia associated with malnutrition and/or electrolyte disturbances Nutrition and correct electrolyte abnormalities, increased QTc – bed rest, discuss with cardiologist; medication for arrhythmia or bradycardia likely to be unhelpful unless symptomatic or tachycardic ; should correct
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IV ACCESS , U/E
HDU MONITORING
It was recommended that patients with AN who are admitted to the hospital with a HR of less than 35 bpm should have continuous monitoring. Medication such as inotropic drugs should be avoided and are contraindicated because of the possibility of additional potential ventricular arrhythmias
ECG (especially if bradycardic or any other CVS complication) Other cause for bradycardia (e.g. heart block), arrhythmia, check QTc time (measure using Bazett’s formulaa ), check electrolytes Prolonged QTc, heart rate <50 bpm, arrhythmia associated with malnutrition and/or electrolyte disturbances Nutrition and correct electrolyte abnormalities, increased QTc – bed rest, discuss with cardiologist; medication for arrhythmia or bradycardia likely to be unhelpful unless symptomatic or tachycardic ; should correct
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Eat Weight Disord. 2019 Apr;24(2):199-207. doi: 10.1007/s40519-018-0567-1. Epub 2018 Sep 1.
Anorexia nervosa and heart disease: a systematic review.
Author information
- 1
- Clinic of Cardiovascular Disease, Policlinico San Martino-IST, Largo Rosanna Benzi, Genoa, Italy. Stefano.giovi88@gmail.com.
- 2
- Clinical Nutrition Unit, Policlinico San Martino-IST, Genoa, Italy.
- 3
- Clinic of Cardiovascular Disease, Policlinico San Martino-IST, Largo Rosanna Benzi, Genoa, Italy.
- 4
- ASL 3 Genovese, Genoa, Italy.
Abstract
Anorexia nervosa (AN) is an eating disorder that most frequently afflicts females in adolescence. In these subjects, cardiovascular complications are the main cause of morbidity and mortality. Aim of this review is to analyze the hemodynamic, pro-arrhythmic and structural changes occurring during all phases of this illness, including re-feeding. A systematic literature search was performed on studies in the MEDLINE database, from its inception until September 2017, with PUBMED interface focusing on AN and cardiovascular disease. This review demonstrated that the most common cardiac abnormalities in AN are bradycardia and QT interval prolongation, which may occasionally degenerate into ventricular arrhythmias such as Torsades des Pointes or ventricular fibrillation. As these arrhythmias may be the substrate of sudden cardiac death (SCD), they require cardiac monitoring in hospital. In addition, reduced cardiac mass, with smaller volumes and decreased cardiac output, may be found. Furthermore, mitral prolapse and a mild pericardial effusion may occur, the latter due to protein deficiency and low levels of thyroid hormone. In anorectic patients, some cases of hypercholesterolemia may be present; however, conclusive evidence that AN is an atherogenic condition is still lacking, although a few cases of myocardial infarction have been reported. Finally, refeeding syndrome (RFS), which occurs during the first days of refeeding, may engender a critically increased risk of acute, life-threatening cardiac complications
Rev Med Chil. 2019;147(1):47-52. doi: 10.4067/S0034-98872019000100047.
[Female adolescents with eating disordes: cardiac abnormalities].
[Article in Spanish]
Marín B V1, Rybertt V1, Briceño AM1, Abufhele M1, Donoso P1, Cruz M1, Silva A1, Palacios C1, Cea L1, Sommer K1.
Author information
- 1
- Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile.
Abstract
BACKGROUND:
Cardiovascular complications can occur in up to 80% of adolescent patients with eating disorders (ED) and account for 30% of their mortality.
AIM:
To evaluate cardiovascular complications in adolescents with ED and their evolution after refeeding.
PATIENTS AND METHODS:
In adolescents with ED admitted to treatment, we assessed the nutritional status, weight loss prior to consultation, presence of bradycardia (BC, defined as heart rate < 60 bpm), we performed an electrocardiogram (ECG) and an echocardiography and measured thyroid hormones.
RESULTS:
We studied 53 women aged 16.4 ± 2.3 years. Fifteen had a diagnosis of Anorexia Nervosa (AN), seven of Bulimia (BN), eight a not otherwise specified ED (ED-NOS), four a Binge Eating Disorder (BED), sixteen an Atypical Anorexia (AAN) and three an Atypical Bulimia (ABN). Thirty four percent were malnourished and 3.8% overweight. The most common cardiac problem was BC in 51%. In eight of 26 patients in whom an echocardiogram was done, it was abnormal. Six had a decreased ventricular mass, three a pericardial effusion and three valvular involvement. There was a significant association between bradycardia and malnutrition, weight loss and low free triiodothyronine levels. BC was significantly more common in patients with AN, but it also occurred in half of the patients with AAN and in one of three patients with other types of ED. At follow up, bradycardia significantly improved with refeeding.
CONCLUSIONS:
There is an association between all types of ED and bradycardia, as well as anatomical and functional cardiac anomalies.
Bradycardia
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Heart muscle wasting, associated with arrhythmias and sudden death (common in anorexia nervosa)
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