An Endomyocardial Biopsy of the Left Ventricle in an Anorexia Nervosa Patient with Sinus Bradycardia and Left Ventricular Systolic Dysfunction

Abstract

Anorexia nervosa (AN) is an eating disorder characterized by an abnormally low body weight, an intense fear of gaining weight, and a distorted perception of body weight. AN is a life-threatening condition that significantly increases the risk of death due to cardiac complications, such that at least one-third of all deaths in patients with AN are associated with cardiac causes including sudden death. In many reports, sudden death has been linked to reduced left ventricular function, structural changes, and QT abnormalities. However, the mechanistic details connecting AN to cardiac abnormalities remain unknown. Here we present an endomyocardial biopsy of the left ventricle in a case of AN with a reversible left ventricular systolic dysfunction.

Long‐term cardiac arrhythmia and chronotropic evaluation in patients with severe anorexia nervosa (LACE‐AN): A pilot study

“…1 Importantly, AN carries one of the highest mortality rates of any psychiatric illness, with a six-fold higher estimated death rate compared with age-matched peers. 5 In addition, patients with AN have been shown to have myocardial fibrosis, demonstrated by late gadolinium enhancement on cardiac magnetic resonance imaging, 6 endomyocardial biopsy, 7 and autopsy reports, 8 implicating a primary substrate for ventricular tachyarrhythmias. While AN is known to alter cardiovascular structure and function, and possibly cardiac repolarization, whether these abnormalities represent a mechanistic link to the high risk of sudden death in AN remains uncertain, primarily because definitive data on the occurrence of premorbid cardiac arrhythmias are sparse.…”

“…3,4 A number of cardiac structural abnormalities, including pericardial effusion and myocardial atrophy, are prevalent in patients with AN. 5 In addition, patients with AN have been shown to have myocardial fibrosis, demonstrated by late gadolinium enhancement on cardiac magnetic resonance imaging, 6 endomyocardial biopsy, 7 and autopsy reports, 8 implicating a primary substrate for ventricular tachyarrhythmias. However, the contribution of these structural abnormalities to the risk of sudden death in AN remains unknown.…”

Somatic complications and nutritional management of anorexia nervosa

“…Cardiac abnormalities may involve the myocardium, the pericardium, the mitral valve and/or the heart related conduction system. Cardiac histological studies reported vacuolar degeneration, myocardium attenuation and moderate interstitial fibrosis, without inflammatory or necrosis features [10]. Clinical observations includes left ventricular dysfunction, cardiac hypotrophy, mitral valve prolapse, pericardial effusion [4,11] and QT long prolongation.…”