Abstract
Anorexia nervosa, one of the more frequent and severe eating disorders, is a chronic psychiatric disease with potentially serious somatic consequences. This behavioral symptomatology leads to weight loss, undernutrition, and more or less severe—potentially life-threatening—somatic complications including respiratory, hepatic, digestive and cardiac features, electrolyte disturbances, endocrine and bone impairment, immunodepression, and related opportunistic infections. In this review, the authors report an overview of cardiac diseases in this disease.
Similar content being viewed by others
References
Herzog W, Deter HC, Fiehn W, Petzold E (1997) Medical findings and predictors of long-term physical outcome in anorexia nervosa: a prospective, 12-year follow-up study. Psychol Med 27(2):269–279
Miller KK, Grinspoon SK, Ciampa J, Hier J, Herzog D, Klibanski A (2005) Medical findings in outpatients with anorexia nervosa. Arch Intern Med 165(5):561–566
(2013) American Psychiatric Association, Diagnostic and statistical manual of mental disorders, 338–45 (5th ed.).
de Simone G, Scalfi L, Galderisi M, Celentano A, Di Biase G, Tammaro P et al (1994) Cardiac abnormalities in young women with anorexia nervosa. Br Heart J 71(3):287–292
Goldberg SJ, Comerci GD, Feldman L (1988) Cardiac output and regional myocardial contraction in anorexia nervosa. J Adolesc Health Care 9(1):15–21
Morris R, Prasad A, Asaro J, Guzman M, Sanders L, Hauck A et al (2017) Markers of cardiovascular dysfunction in adolescents with anorexia nervosa. Glob Pediatr Health 4:2333794X17727423
Casiero D, Frishman WH (2006) Cardiovascular complications of eating disorders. Cardiol Rev 14(5):227–231
Di Cola G, Jacoangeli F, Jacoangeli F, Lombardo M, Iellamo F (2014) Cardiovascular disorders in anorexia nervosa and potential therapeutic targets. Intern Emerg Med 9(7):717–721
Olivares JL, Vázquez M, Fleta J, Moreno LA, Pérez-González JM, Bueno M (2005) Cardiac findings in adolescents with anorexia nervosa at diagnosis and after weight restoration. Eur J Pediatr 164(6):383–386
Sachs KV, Harnke B, Mehler PS, Krantz MJ (2016) Cardiovascular complications of anorexia nervosa: a systematic review. Int J Eat Disord 49(3):238–248
Takahashi S, Mine T (2016) An endomyocardial biopsy of the left ventricle in an anorexia nervosa patient with sinus bradycardia and left ventricular systolic dysfunction. Case Rep Cardiol 2016:9805291
Romano C, Chinali M, Pasanisi F, Greco R, Celentano A, Rocco A, Palmieri V, Signorini A, Contaldo F, de Simone G (2003) Reduced hemodynamic load and cardiac hypotrophy in patients with anorexia nervosa. Am J Clin Nutr 77(2):308–312
Palla B, Litt IF (1988) Medical complications of eating disorders in adolescents. Pediatrics 81(5):613–623
Galetta F, Franzoni F, Prattichizzo F, Rolla M, Santoro G, Pentimone F (2003) Heart rate variability and left ventricular diastolic function in anorexia nervosa. J Adolesc Health 32(6):416–421
Thurston J, Marks P (1974) Electrocardiographic abnormalities in patients with anorexia nervosa. Br Heart J 36(7):719–723
Krantz MJ, Sabel AL, Sagar U, Long CS, Barbey JT, White KV et al (2012) Factors influencing QT prolongation in patients hospitalized with severe anorexia nervosa. Gen Hosp Psychiatry 34(2):173–177
Dec GW, Biederman J, Hougen TJ (1987) Cardiovascular findings in adolescent inpatients with anorexia nervosa. Psychosom Med 49(3):285–290
Nudel DB, Gootman N, Nussbaum MP, Shenker IR (1984) Altered exercise performance and abnormal sympathetic responses to exercise in patients with anorexia nervosa. J Pediatr 105(1):34–37
Kollai M, Bonyhay I, Jokkel G, Szonyi L (1994) Cardiac vagal hyperactivity in adolescent anorexia nervosa. Eur Heart J 15(8):1113–1118
Kanbur NO, Goldberg E, Pinhas L, Hamilton RM, Clegg R, Katzman DK (2009) Second-degree atrioventricular block (Mobitz Type I) in an adolescent with anorexia nervosa: intrinsic or acquired conduction abnormality. Int J Eat Disord 42(6):575–578
Bravender T, Kanter R, Zucker N (2006) Anorexia nervosa and second-degree atrioventricular block (Type I). Int J Eat Disord 39(7):612–615
Kossaify A (2010) Management of sinus node dysfunction with junctional escape rhythm in a case of anorexia nervosa. Turk Kardiyol Dern Ars 38(7):486–488
Lombardi F (1998) The QT interval and QT dispersion: ‘the smaller, the better’. Eur Heart J 19(9):1279–1281
Hill JA, Friedman PL (1997) Measurement of QT interval and QT dispersion. Lancet 349(9056):894–895
Oka Y, Ito T, Sekine I, Sada T, Okabe F, Naito A, Matsumoto S, Suematsu H, Kuboki T, Nomura S (1984) Mitral valve prolapse in patients with anorexia nervosa. J Cardiogr 14(3):483–491
Krantz MJ, Donahoo WT, Melanson EL, Mehler PS (2005) QT interval dispersion and resting metabolic rate in chronic anorexia nervosa. Int J Eat Disord 37(2):166–170
Keys A (1950) The residues of malnutrition and starvation. Science 112(2909):371–373
St John Sutton MG, Plappert T, Crosby L, Douglas P, Mullen J, Reichek N (1985) Effects of reduced left ventricular mass on chamber architecture, load, and function: a study of anorexia nervosa. Circulation 72(5):991–1000
Silvetti MS, Magnani M, Santilli A, Di Liso G, Diamanti A, Pompei E et al (1998) The heart of anorexic adolescents. G Ital Cardiol 28(2):131–139
Schocken DD, Holloway JD, Powers PS (1989) Weight loss and the heart. Effects of anorexia nervosa and starvation. Arch Intern Med 149(4):877–878
Ravaldi C, Vannacci A, Ricca V (2003) Cardiac complications of anorexia nervosa. Recenti Prog Med 94(6):267–270
Gottdiener JS, Gross HA, Henry WL, Borer JS, Ebert MH (1978) Effects of self-induced starvation on cardiac size and function in anorexia nervosa. Circulation 58(3 Pt 1):425–433
Galetta F, Franzoni F, Cupisti A, Morelli E, Santoro G, Pentimone F (2005) Early detection of cardiac dysfunction in patients with anorexia nervosa by tissue Doppler imaging. Int J Cardiol 101(1):33
Escudero CA, Potts JE, Lam PY, De Souza AM, Mugford GJ, Sandor GG (2016) An echocardiographic study of left ventricular size and cardiac function in adolescent females with anorexia nervosa. Eur Eat Disord Rev 24(1):26–33
Eidem BW, Cetta F, Webb JL, Graham LC, Jay MS (2001) Early detection of cardiac dysfunction: use of the myocardial performance index in patients with anorexia nervosa. J Adolesc Health 29(4):267–270
García-Rubira JC, Hidalgo R, Gómez-Barrado JJ, Romero D, Cruz Fernández JM (1994) Anorexia nervosa and myocardial infarction. Int J Cardiol 45(2):138–140
Ohwada R, Hotta M, Kimura H, Takagi S, Matsuda N, Nomura K, Takano K (2005) Ampulla cardiomyopathy after hypoglycemia in three young female patients with anorexia nervosa. Intern Med 44(3):228–233
Volman MN, Ten Kate RW, Tukkie R (2011) Tako Tsubo cardiomyopathy, presenting with cardiogenic shock in a 24-year-old patient with anorexia nervosa. Neth J Med 69(3):129–131
Mont L, Castro J, Herreros B, Paré C, Azqueta M, Magriña J, Puig J, Toro J, Brugada J (2003) Reversibility of cardiac abnormalities in adolescents with anorexia nervosa after weight recovery. J Am Acad Child Adolesc Psychiatry 42(7):808–813
DiVasta AD, Walls CE, Feldman HA, Quach AE, Woods ER, Gordon CM, Alexander ME (2010) Malnutrition and hemodynamic status in adolescents hospitalized for anorexia nervosa. Arch Pediatr Adolesc Med 164(8):706–713
Kastner S, Salbach-Andrae H, Renneberg B, Pfeiffer E, Lehmkuhl U, Schmitz L (2012) Echocardiographic findings in adolescents with anorexia nervosa at beginning of treatment and after weight recovery. Eur Child Adolesc Psychiatry 21(1):15–21
Lelli L, Rotella F, Castellini G, Benni L, Lo Sauro C, Barletta G, Mannucci E, Castellani S, di Tante V, Galanti G, Ricca V (2015) Echocardiographic findings in patients with eating disorders: a case-control study. Nutr Metab Cardiovasc Dis 25(7):694–696
Cariem AK, Lemmer ER, Adams MG, Winter TA, O’Keefe SJ (1994) Severe hypophosphataemia in anorexia nervosa. Postgrad Med J 70(829):825–827
Davidson A, Anisman PC, Eshaghpour E (1992) Heart failure secondary to hypomagnesemia in anorexia nervosa. Pediatr Cardiol 13(4):241–242
Winston AP, Jamieson CP, Madira W, Gatward NM, Palmer RL (2000) Prevalence of thiamin deficiency in anorexia nervosa. Int J Eat Disord 28(4):451–454
Oflaz S, Yucel B, Oz F, Sahin D, Ozturk N, Yaci O, Polat N, Gurdal A, Cizgici AY, Dursun M, Oflaz H (2013) Assessment of myocardial damage by cardiac MRI in patients with anorexia nervosa. Int J Eat Disord 46(8):862–866
Inagaki T, Yamamoto M, Tsubouchi K, Miyaoka T, Uegaki J, Maeda T et al (2003) Echocardiographic investigation of pericardial effusion in a case of anorexia nervosa. Int J Eat Disord 33:364–366
Kircher JN, Park MH, Cheezum MK, Hulten EA, Kunz JS, Haigney M, Atwood JE (2012) Cardiac tamponade in association with anorexia nervosa: a case report and review of the literature. Cardiol J 19(6):635–638
Polli N, Blengino S, Moro M, Zappulli D, Scacchi M, Cavagnini F (2006) Pericardial effusion requiring pericardiocentesis in a girl with anorexia nervosa. Int J Eat Disord 39:609–611
Docx MK, Gewillig M, Simons A, Vandenberghe P, Weyler J, Ramet J, Mertens L (2010) Pericardial effusions in adolescent girls with anorexia nervosa: clinical course and risk factors. Eat Disord 18(3):218–225
Johnson GL, Humphries LL, Shirley PB, Mazzoleni A, Noonan JA (1986) Mitral valve prolapse in patients with anorexia nervosa and bulimia. Arch Intern Med 146(8):1525–1529
Ulger Z, Gürses D, Ozyurek AR, Arikan C, Levent E, Aydoğdu S (2006) Follow-up of cardiac abnormalities in female adolescents with anorexia nervosa after refeeding. Acta Cardiol 61(1):43–49
Bär KJ, Boettger S, Wagner G, Wilsdorf C, Gerhard UJ, Boettger MK, Blanz B, Sauer H (2006) Changes of pain perception, autonomic function, and endocrine parameters during treatment of anorectic adolescents. J Am Acad Child Adolesc Psychiatry 45(9):1068–1076
Cooke RA, Chambers JB, Singh R, Todd GJ, Smeeton NC, Treasure J, Treasure T (1994) QT interval in anorexia nervosa. Br Heart J 72(1):69–73
Golden NH, Meyer W (2004) Nutritional rehabilitation of anorexia nervosa. Goals and dangers. Int J Adolesc Med Health 16(2):131–144
Mehanna HM, Moledina J, Travis J (2008) Refeeding syndrome: what it is, and how to prevent and treat it. BMJ 336(7659):1495–1498
Löwe B, Zipfel S, Buchholz C, Dupont Y, Reas DL, Herzog W (2001) Long-term outcome of anorexia nervosa in a prospective 21-year follow-up study. Psychol Med 31(5):881–890
Crisp AH, Callender JS, Halek C, Hsu LK (1992) Long-term mortality in anorexia nervosa. A 20-year follow-up of the St George’s and Aberdeen cohorts. Br J Psychiatry 161:104–107
Signorini A, De Filippo E, Panico S, De Caprio C, Pasanisi F, Contaldo F (2007) Long-term mortality in anorexia nervosa: a report after an 8-year follow-up and a review of the most recent literature. Eur J Clin Nutr 61(1):119–122
Emborg C (2001) Mortality and causes of death in patients with eating disorders in Denmark, 1970-1993. Ugeskr Laeger 163(25):3476–3480
Sullivan PF (1995) Mortality in anorexia nervosa. Am J Psychiatry 152(7):1073–1074
Arcelus J, Mitchell AJ, Wales J, Nielsen S (2011) Mortality rates in patients with anorexia nervosa and other eating disorders. A meta-analysis of 36 studies. Arch Gen Psychiatry 68(7):724–731
Huas C, Caille A, Godart N, Foulon C, Pham-Scottez A, Divac S, Dechartres A, Lavoisy G, Guelfi JD, Rouillon F, Falissard B (2011) Factors predictive of ten-year mortality in severe anorexia nervosa patients. Acta Psychiatr Scand 123(1):62–70
Herzog DB, Copeland PM (1985) Eating disorders. N Engl J Med 313(5):295–303
Turillazzi E, Bello S, Neri M, Pomara C, Riezzo I, Fineschi V (2013) Congestive heart failure as cause of death in an anorexia nervosa fatal case. Int J Cardiol 165(2):e28–e29
Steinhausen HC, Seidel R (1993) Outcome in adolescent eating disorders. Int J Eat Disord 14(4):487–496
Patton GC (1988) Mortality in eating disorders. Psychol Med 18(4):947–951
Neumärker KJ (1997) Mortality and sudden death in anorexia nervosa. Int J Eat Disord 21(3):205–212
Isner JM, Roberts WC, Heymsfield SB, Yager J (1985) Anorexia nervosa and sudden death. Ann Intern Med 102(1):49–52
Facchini M, Sala L, Malfatto G, Bragato R, Redaelli G, Invitti C (2006) Low-K+ dependent QT prolongation and risk for ventricular arrhythmia in anorexia nervosa. Int J Cardiol 106(2):170–176
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflicts of interest.
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Fayssoil, A., Melchior, J.C. & Hanachi, M. Heart and anorexia nervosa. Heart Fail Rev 26, 65–70 (2021). https://doi.org/10.1007/s10741-019-09911-0
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10741-019-09911-0