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Complications of Eating Disorders - Cardiac Complications

Some of the most common medical complications of eating disorders are those related to the heart. Cardiac complications from anorexia nervosa, along with suicide, are the leading causes of death from this diagnosis. Cardiac complications are often present with bulimia nervosa as well, and can also be fatal. Cardiac complications from anorexia are sometimes predictable, but often not. The predictability can arise because symptoms such as slow heart rate, (bradycardyia), and significant changes in blood pressure and pulse between laying and standing (orthostasis) may be present. Both of these symptoms may predict future cardiac risks and dangers. However, the main danger to the heart is electrolyte imbalance in the face of a weakened heart. This, combined with the loss of heart mass, can occur before all the weight loss has occurred. Therefore, it is not just the extremely underweight who are at risk.

In people with anorexia, cardiac changes that appear on an electrocardiogram may also occur. This particular change, called a prolonged QT interval, is also a predictor of fatality for a patient with anorexia. In general, individuals with prolonged QT intervals will require hospitalization. The only way to know if a QT interval is prolonged is by obtaining an electrocardiogram, which should be a routine recommendation in the assessment of an eating disorder.

For patients with bulimia, death from cardiac issues is usually due to changes in their electrolytes, particularly changes in potassium, magnesium, and phosphorus. Because these changes are impacted by purging behaviors, death from bulimia is often sudden and unpredictable. Patients who use ipecac to induce vomiting increase their risk for death from cardiac issues by a different mechanism. Ipecac is toxic to the heart and essentially poisons the cardiac muscle, which can result in death.

Common symptoms someone might experience if they are at risk for cardiac abnormalities include: tiredness, lightheadedness, fainting, heart palpitations, chest pain, shortness of breath, and reduced tolerance to exercise. Anyone with these changes should have an assessment immediately. Although dangerous, cardiac changes can be treated, and the treatment for them is straightforward. They all involve bed rest, stopping all behaviors, and in some cases, hospitalization. If cardiac complications are present, treatment for the eating disorder is an absolute immediate necessity and will usually include refeeding and the establishment of a safe and healthy meal plan. The body is wise enough to repair the heart as soon as it has a chance and the resolution of cardiac complications is an early sign of improvement in the healing of an eating disorder.

A special thank you to our consultant for this post, Dr. Ellen Rome from The Cleveland Clinic Foundation.