Reversibility of Cardiac Abnormalities in Adolescents With Anorexia Nervosa After Weight Recovery

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

“…14 In the literature on adults with eating disorders, the electrocardiographic finding of increased QTc dispersion has been associated with ventricular arrhythmias and sudden death. Unlike Panagiotopoulos et al, 4 who did not find increased QTc dispersion in adolescents with AN versus controls, both Mont et al 3 and Swenne and Thurfjell 7 reported increased dispersion of the QTc interval.…”

“…21 Reports have demonstrated that adolescents with AN have loss of cardiac muscle detected by a decrease in left ventricular wall thickness. 3,9,11,22 Furthermore, reduced cardiac output also has been documented in adolescents with AN at initial assessment. 3,17 In one study, the majority of adolescents with AN had decreased left ventricular mass and cardiac output at the basal state, indicating early structural and functional heart involvement.…”

“…3,4 In fact, even with a short duration of illness, there are both functional and structural cardiac abnormalities that appear to be reversible with early identification and treatment. 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.…”

“…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.…”

“…In contrast, other studies in adolescents with AN have found no prolongation of the QTc interval (prolonged QTc interval was defined as 0.44 ms or as >0.44 ms). 1,3,4 Because the finding of a prolonged QTc interval may still be concerning, a normal QTc should not reassure the clinician that the adolescent with AN is not severely ill.…”