Skip to main content

Advertisement

Log in

Heart and anorexia nervosa

  • Published:
Heart Failure Reviews Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  1. 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

    PubMed  CAS  Google Scholar 

  2. 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

    PubMed  Google Scholar 

  3. (2013) American Psychiatric Association, Diagnostic and statistical manual of mental disorders, 338–45 (5th ed.).

  4. 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

    PubMed  PubMed Central  Google Scholar 

  5. Goldberg SJ, Comerci GD, Feldman L (1988) Cardiac output and regional myocardial contraction in anorexia nervosa. J Adolesc Health Care 9(1):15–21

    PubMed  CAS  Google Scholar 

  6. 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

    PubMed  PubMed Central  Google Scholar 

  7. Casiero D, Frishman WH (2006) Cardiovascular complications of eating disorders. Cardiol Rev 14(5):227–231

    PubMed  Google Scholar 

  8. 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

    PubMed  Google Scholar 

  9. 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

    PubMed  Google Scholar 

  10. 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

    PubMed  Google Scholar 

  11. 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

    PubMed  PubMed Central  Google Scholar 

  12. 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

    PubMed  CAS  Google Scholar 

  13. Palla B, Litt IF (1988) Medical complications of eating disorders in adolescents. Pediatrics 81(5):613–623

    PubMed  CAS  Google Scholar 

  14. 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

    PubMed  Google Scholar 

  15. Thurston J, Marks P (1974) Electrocardiographic abnormalities in patients with anorexia nervosa. Br Heart J 36(7):719–723

    PubMed  PubMed Central  CAS  Google Scholar 

  16. 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

    PubMed  Google Scholar 

  17. Dec GW, Biederman J, Hougen TJ (1987) Cardiovascular findings in adolescent inpatients with anorexia nervosa. Psychosom Med 49(3):285–290

    PubMed  CAS  Google Scholar 

  18. 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

    PubMed  CAS  Google Scholar 

  19. Kollai M, Bonyhay I, Jokkel G, Szonyi L (1994) Cardiac vagal hyperactivity in adolescent anorexia nervosa. Eur Heart J 15(8):1113–1118

    PubMed  CAS  Google Scholar 

  20. 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

    PubMed  Google Scholar 

  21. Bravender T, Kanter R, Zucker N (2006) Anorexia nervosa and second-degree atrioventricular block (Type I). Int J Eat Disord 39(7):612–615

    PubMed  Google Scholar 

  22. 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

    PubMed  Google Scholar 

  23. Lombardi F (1998) The QT interval and QT dispersion: ‘the smaller, the better’. Eur Heart J 19(9):1279–1281

    PubMed  CAS  Google Scholar 

  24. Hill JA, Friedman PL (1997) Measurement of QT interval and QT dispersion. Lancet 349(9056):894–895

    PubMed  CAS  Google Scholar 

  25. 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

    PubMed  CAS  Google Scholar 

  26. 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

    PubMed  Google Scholar 

  27. Keys A (1950) The residues of malnutrition and starvation. Science 112(2909):371–373

    PubMed  CAS  Google Scholar 

  28. 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

    PubMed  CAS  Google Scholar 

  29. 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

    PubMed  CAS  Google Scholar 

  30. 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

    PubMed  CAS  Google Scholar 

  31. Ravaldi C, Vannacci A, Ricca V (2003) Cardiac complications of anorexia nervosa. Recenti Prog Med 94(6):267–270

    PubMed  Google Scholar 

  32. 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

    PubMed  CAS  Google Scholar 

  33. 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

    PubMed  Google Scholar 

  34. 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

    PubMed  Google Scholar 

  35. 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

    PubMed  CAS  Google Scholar 

  36. 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

    PubMed  Google Scholar 

  37. 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

    PubMed  Google Scholar 

  38. 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

    PubMed  CAS  Google Scholar 

  39. 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

    PubMed  Google Scholar 

  40. 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

    PubMed  PubMed Central  Google Scholar 

  41. 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

    PubMed  Google Scholar 

  42. 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

    PubMed  CAS  Google Scholar 

  43. Cariem AK, Lemmer ER, Adams MG, Winter TA, O’Keefe SJ (1994) Severe hypophosphataemia in anorexia nervosa. Postgrad Med J 70(829):825–827

    PubMed  PubMed Central  CAS  Google Scholar 

  44. Davidson A, Anisman PC, Eshaghpour E (1992) Heart failure secondary to hypomagnesemia in anorexia nervosa. Pediatr Cardiol 13(4):241–242

    PubMed  CAS  Google Scholar 

  45. 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

    PubMed  CAS  Google Scholar 

  46. 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

    PubMed  Google Scholar 

  47. 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

    PubMed  Google Scholar 

  48. 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

    PubMed  Google Scholar 

  49. 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

    PubMed  Google Scholar 

  50. 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

    PubMed  Google Scholar 

  51. 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

    PubMed  CAS  Google Scholar 

  52. 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

    PubMed  Google Scholar 

  53. 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

    PubMed  Google Scholar 

  54. 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

    PubMed  PubMed Central  CAS  Google Scholar 

  55. Golden NH, Meyer W (2004) Nutritional rehabilitation of anorexia nervosa. Goals and dangers. Int J Adolesc Med Health 16(2):131–144

    PubMed  Google Scholar 

  56. Mehanna HM, Moledina J, Travis J (2008) Refeeding syndrome: what it is, and how to prevent and treat it. BMJ 336(7659):1495–1498

    PubMed  PubMed Central  Google Scholar 

  57. 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

    PubMed  Google Scholar 

  58. 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

    PubMed  CAS  Google Scholar 

  59. 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

    PubMed  CAS  Google Scholar 

  60. Emborg C (2001) Mortality and causes of death in patients with eating disorders in Denmark, 1970-1993. Ugeskr Laeger 163(25):3476–3480

    PubMed  CAS  Google Scholar 

  61. Sullivan PF (1995) Mortality in anorexia nervosa. Am J Psychiatry 152(7):1073–1074

    PubMed  CAS  Google Scholar 

  62. 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

    PubMed  Google Scholar 

  63. 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

    PubMed  CAS  Google Scholar 

  64. Herzog DB, Copeland PM (1985) Eating disorders. N Engl J Med 313(5):295–303

    PubMed  CAS  Google Scholar 

  65. 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

    PubMed  Google Scholar 

  66. Steinhausen HC, Seidel R (1993) Outcome in adolescent eating disorders. Int J Eat Disord 14(4):487–496

    PubMed  CAS  Google Scholar 

  67. Patton GC (1988) Mortality in eating disorders. Psychol Med 18(4):947–951

    PubMed  CAS  Google Scholar 

  68. Neumärker KJ (1997) Mortality and sudden death in anorexia nervosa. Int J Eat Disord 21(3):205–212

    PubMed  Google Scholar 

  69. Isner JM, Roberts WC, Heymsfield SB, Yager J (1985) Anorexia nervosa and sudden death. Ann Intern Med 102(1):49–52

    PubMed  CAS  Google Scholar 

  70. 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

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Abdallah Fayssoil.

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

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

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

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10741-019-09911-0

Keywords

Navigation