Myocardial Changes in a Patient With Anorexia Nervosa

Lamzabi, Ihab; Syed, Sahr; Reddy, Vijaya B.; Jain, Richa; Harbhajanka, Aparna; Arunkumar, Ponni

doi:10.1309/ajcp4plff1ttkent

Cited by 34 publications

(18 citation statements)

References 14 publications

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“…This study corroborates older data suggesting regional myocardial contraction abnormalities in patients in the acute phase of eating disorders . Although echocardiographic atrophy and fibrosis by MRI have been demonstrated, cardiac histologic abnormalities have been poorly characterized until very recently: a published autopsy report showed left ventricular atrophy with endocardial and interstitial fibrosis, focal myxoid material deposition with mast cells, and increased cytoplasmic lipofuscin . These findings may suggest the presence of an important risk of sudden cardiac death that is independent of delayed repolarization.…”

Section: Methodssupporting

confidence: 89%

“…19 Although echocardiographic atrophy and fibrosis by MRI have been demonstrated, cardiac histologic abnormalities have been poorly characterized until very recently: a published autopsy report showed left ventricular atrophy with endocardial and interstitial fibrosis, focal myxoid material deposition with mast cells, and increased cytoplasmic lipofuscin. 32 These findings may suggest the presence of an important risk of sudden cardiac death that is independent of delayed repolarization. Although most cardiac structural abnormalities are reversible in this condition, the presence of myocardial scar suggests that malignant arrhythmias due to underlying structural heart disease remain a possible mechanism of increased mortality in this disease.…”

Section: Structural Complicationsmentioning

confidence: 94%

“…Two small studies also found the QTc interval to be longer in adolescent patients with anorexia nervosa than in healthy controls . and similarly, in adult anorexia nervosa patients . However, the association between anorexia and delayed repolarization this remains questionable due to limited sample size, varying degrees of anorexia nervosa severity and stages of weight restoration and patient types in previously evaluated cohorts.…”

Section: Methodsmentioning

confidence: 99%

See 2 more Smart Citations

Cardiovascular complications of anorexia nervosa: A systematic review

Sachs

Harnke

Mehler

et al. 2015

Intl J Eating Disorders

181

172

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It is reasonable to obtain routine electrocardiography and measurements of orthostatic vital signs in patients presenting with anorexia nervosa. Echocardiography is generally not indicated unless prompted by clinical signs of disease. Admission to an inpatient unit with telemetry monitoring is recommended for patients with severe sinus bradycardia or junction rhythm, marked prolongation of the corrected QT interval, or syncope.

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Section: Methodssupporting

confidence: 89%

Section: Structural Complicationsmentioning

confidence: 94%

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Cardiovascular complications of anorexia nervosa: A systematic review

Sachs

Harnke

Mehler

et al. 2015

Intl J Eating Disorders

181

172

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“…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.…”

Section: Introductionmentioning

confidence: 99%

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

Farasat

Watters

Bendelow

et al. 2020

Cardiovasc electrophysiol

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Background: Anorexia nervosa (AN) is associated with autonomic dysfunction and carries a high risk of sudden death, putatively attributed to ventricular tachyarrhythmias. To date, long-term cardiac monitoring has not been performed to confirm this speculation. Methods and Results:We assessed the safety and acceptability of an insertable cardiac monitor (ICM) in patients with severe AN with markedly reduced body mass index (BMI), and investigated heart rate (HR) and rhythm before and after weight restoration. Autonomic function was assessed as HR response to a standardized activity protocol at baseline and four additional visits over 360 days. The Florida Patient Acceptance Survey (FPAS) was used to measure ICM acceptability.During a mean follow-up of 10 months, no ICM-related complications occurred and ICM was well-accepted by the 11 study participants (nine women, aged 19-59 years, baseline BMI = 12.7 ± 1.6 kg/m 2 ). Both resting and peak HR increased with weight restoration and were directly associated with BMI (both P < .001). No ventricular tachyarrhythmias occurred during the study period, but two participants (18%) experienced eight sinus pauses (3.0-7.0 seconds) and three runs of supraventricular tachycardia.Conclusions: Long-term cardiac rhythm monitoring with an ICM is feasible, safe, and acceptable in patients with severe AN. Autonomic dysfunction in AN results in not only profound resting bradycardia, but also some degree of chronotropic incompetence, both of which improve with weight restoration. Clinically significant bradyarrhythmias are more common than ventricular tachyarrhythmias in AN, and may represent a competing underlying mechanism for the high risk of sudden death in this population. K E Y W O R D Sadult, anorexia nervosa, autonomic dysfunction, long-term cardiac monitoring

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“…One study demonstrated myocardial fibrosis/scar manifested by late gadolinium enhancement on magnetic resonance imaging (MRI) in nearly a quarter of patients 61. Although echocardiographic atrophy and fibrosis by MRI have been demonstrated, histologic abnormalities in the heart have been poorly characterized until very recently: a published autopsy report showed left ventricular atrophy with endocardial and interstitial fibrosis, focal myxoid material deposition with mast cells, and increased cytoplasmic lipofuscin 62. Although most cardiac structural…”

mentioning

confidence: 99%