Heart failure in anorexia nervosa: Case report and review of the literature

Abstract

If shortness of breath occurs in AN it may be a symptom of heart failure. The diagnosis is further suggested by increased jugular venous pressure, increasing shortness of breath on exertion, and pulmonary crepitations at the bases of the lungs on physical examination. The chest x-ray usually shows pulmonary venous redistribution, the electrocardiogram may be normal, and the echocardiogram should document a reduced left ventricular ejection fraction. Standard medical therapy for heart failure should be started. In addition, a history of ipecac use should be taken, deficiencies should be corrected, and weight restoration can reverse cardiac abnormalities.

Cardiac changes in anorexia nervosa

“…40 The exact link between structural alterations and decreased cardiac function found in anorexia nervosa is not clear. Specific electrolyte, mineral, and other chemical deficiencies are known to impact contractility including hypomagnesaemia, hypophosphataemia, thiamine or selenium deficiency, [44][45][46][47][48][49][50][51] direct cardiac toxicity from syrup of ipecac, [52][53][54][55][56][57][58][59] thyrotoxicosis, alcohol abuse, 60 and potentially hypoglycaemia 61 and catecholamine overload. 60,62 Many of these same deficiencies and complications exist in patients struggling with restricting and/or purging subtypes of anorexia nervosa.…”

Eating Disorders, Addictions and Substance Use Disorders

“…Hypoglycemia can occur in AN and AUD, especially at very low weight (average BMI of 13) and/or in the presence of liver damage (Gaudiani, Sabel, Mascolo, & Mehler, 2012), which can lead to ketoacidosis, coma, and/or death (Fulop, Ben-Ezra, & Bock, 1986;Rich, Caine, Findling, & Shaker, 1990;Yanai, Yoshida, Tomono, & Tada, 2008). Cardiomyopathy or heart failure can occur in AN and can be due to deficiencies in protein, thiamine, phosphorus, magnesium, selenium, and/or ipecac poisoning (Birmingham & Gritzner, 2007). Some of the behaviors associated with ED can cause exposure to toxins.…”

Cardiac Arrest and Successful Extracorporeal Cardiopulmonary Resuscitation as a Result of a Refeeding Syndrome in a Young Female with Anorexia Nervosa

“…Silent LV dysfunction in patients with AN in the starvation phase is common [ 10 ], and its identification is of importance to prevent heart failure, a complication that often develops during clinical refeeding [ 6 ]. Causes of heart failure in AN patients with severe malnutrition often include deficiencies of magnesium, phosphorus, thiamine, and selenium [ 11 – 13 ]. It is suggested by de Simone et al in 1994 that an abrupt increase in preload developing during refeeding might precipitate heart failure [ 10 ].…”