Pericardial effusions in anorexia nervosa

Abstract

Anorexia nervosa is an eating disorder that may be accompanied by cardiac symptoms of varying severity. So far disturbances like arrhythmias, mitral valve prolapse and loss of cardial ventricle mass have been described. Other somatic complications consist of electrolyte and acid-base imbalances, which in turn influence cardiac function. Between 1990 and 1999 we observed ten case reports from inpatient anorexic female adolescents, who developed pericardial effusions in the course of their illness. The diagnosis and course was revealed by echocardiography. No signs of heart failure could be noticed. In eight patients pericardial effusion remitted completely or partly by a concurrent increase in weight. A distinct pathophysiology for the development of pericardial effusion could not be revealed, but a correlation to restoration of weight seems to exist. Our report suggests that pericardial effusions are more frequent cardiac complications in anorexia nervosa than previously known. In most cases the clinical significance is doubtful.

Cardiac tamponade in association with anorexia nervosa: A case report and review of the literature

“…In view of the literature to date, and the wide prevalence of reported AN-associated pericardial effusions, it is reasonable to consider preoperative echocardiography for patients in whom AN is suspected. *Not applicable or not available; **Referenced in Frolich et al [9]; ***While specific numbers are not listed here, this study reported clinically silent pericardial effusion that was inversely related to body mass index (BMI)…”

“…In these patients, most pericardial effusions resolved with nutritional support only. Conversely, one study of AN patients with pericardial effusions noted a correlation between normalization of body mass and resolution of effusions, yet in those cases there did not appear to be a significant protein deficiency [9].…”

Medical complications in adolescents with anorexia nervosa: A review of the literature

“…3 Upon reviewing the adolescent eating disorder literature, the most common reported cardiovascular complications include electrocardiographic abnormalities such as sinus bradycardia, 1,[3][4][5] decreased voltage and prolonged QTc, 1,3-7 orthostatic hypotension, 8 increased vagal tone, 9,10 poor myocardial contractility, mitral valve prolapse (MVP), reduction in left ventricular wall thickness and mass, 3,9,11 and silent pericardial effusion. 11,12 Electrocardiographic abnormalities are present in most adolescents with AN. 3,4,6,7 Sinus bradycardia is reported to be present in 35-95% of adolescents with AN, 1,[3][4][5] and is believed to be due to the reported increased vagal tone 4,9,10 and decreased metabolic rate.…”

“…11,12 One study described 10 hospitalized adolescents with AN with pericardial effusions discovered on echocardiography. 12 No clinical signs or symptoms of heart failure were observed. In 8 of these adolescents, pericardial effusion remitted with weight rehabilitation.…”

“…In 8 of these adolescents, pericardial effusion remitted with weight rehabilitation. 12 The pathophysiology for the development of pericardial effusion in AN is unknown although there is a correlation with low BMI 11 and weight restoration. 12 The clinical significance remains unclear.…”