Cardiac Complications of Eating Disorders 

Eating disorders can lead to severe cardiac problems, including irregular heartbeats, low blood pressure and sudden cardiac death. These issues arise from malnutrition, electrolyte imbalances and dehydration, which can strain the heart. Early intervention and treatment are crucial to address both the eating disorder and prevent long-term cardiovascular damage.

Cardiac Dysfunction in Eating Disorders

Unlike most other psychiatric conditions that do not have any physical manifestations, eating disorders affect every major organ system, causing medical complications across the entire body, including the cardiovascular system.

Although suicide represents nearly half the mortality in patients with eating disorders, many of the remaining deaths are likely impacted by the cardiovascular complications of eating disorders including bradyarrhythmias, cardiac structural changes and abnormal electrical conduction, along with electrolyte abnormalities and hypoglycemia.

Patients with eating disorders may seek out care or be referred to a cardiologist to address their cardiovascular complications, highlighting the important role cardiologists can play in the identification of eating disorders.

Eating disorders & heart problems

Patients with anorexia nervosa (AN) have a low body weight and decreased lean muscle mass, including reduced cardiac mass. Atrophy of the heart can lead to reduced cardiac output and potentially abnormal cardiac conduction

Patients with bulimia nervosa (BN) are also at risk for abnormal heart rhythms, but with the additional risk of ischemic heart disease, thereby increasing the risk for heart attacks and atherosclerosis, or the buildup of fats and cholesterol in the arterial walls.

Bradycardia

Bradycardia is not only the most common cardiovascular complication, but also the most common complication in general, occurring in up to 95% of patients. Bradycardia includes any heartbeat under 60 beats per minute. Severe and prolonged bradycardia can cause:

• Fainting (syncope)
• Chest discomfort
• Shortness of breath
• Fatigue
• Palpitations, and other nonspecific symptoms

Structural heart disease

Prolonged malnutrition can cause wasting of the cardiac muscle (myocardial atrophy), contributing to structural heart disease in patients with eating disorders and malnutrition. The loss of cardiac muscle mass causes valvular dysfunction, specifically mitral valve prolapse, sometimes causing chest discomfort and palpitations; the valve itself remains healthy but is more lax related to the cardiac atrophy. Cardiac remodeling and scarring can also develop, potentially increasing the risk for dangerous arrhythmias.

Hypotension

Hypotension (low blood pressure) is another frequent manifestation of eating disorders and malnutrition. Patients with abnormally low blood pressure can experience:

• Dizziness
• Nausea
• Fatigue
• Blurred vision
• Fainting

Atherosclerosis

Bulimia nervosa is associated with atherosclerosis, the thickening or hardening of the arteries, typically because of plaque buildup. Atherosclerosis is not fully reversible, and lifestyle changes are necessary to manage coronary artery disease. If left untreated, atherosclerosis can lead to:

• Heart attack
• Stroke
• Reduced blood flow to other vital organs and the extremities

Atherosclerosis can also contribute to the development of coronary artery disease (CAD), also known as ischemic heart disease or coronary heart disease (CHD).

Coronary artery disease

Patients with bulimia nervosa are also at risk for coronary artery disease (CAD). CAD is a narrowing or blockage of the coronary arteries, which supply oxygen-rich blood to the heart, typically due to plaque buildup. CAD develops over time and slowly limits the amount of blood that can reach the heart. Coronary artery disease can cause chest pain, shortness of breath and fatigue. This condition also puts patients at risk for heart attack and sudden cardiac death

Pericardial effusion

The exact mechanism of pericardial effusion (a buildup of too much fluid in the saclike structure around the heart) in eating disorders is poorly understood but may be related to thyroid hormone levels and/or reduced pericardial fat. Patients with pericardial effusions appear to have a lower BMI (body mass index) and lower triiodothyronine (T3) levels. In rare instances, this fluid buildup can encroach upon cardiac hemodynamics, impacting cardiac filling (cardiac tamponade).

Electrolyte disturbances

Electrolyte disturbances are also common in patients with eating disorders, especially those with bulimia nervosa or the binge-purge subtype of anorexia nervosa who engage in purging, are likely to have electrolyte abnormalities. Hypokalemia is one of the most severe complications for patients, as it can lead to various cardiac complications, including:

• Cardiac arrhythmias (irregular heartbeat)
• Conduction disturbances
• Abnormal cardiac pumping

Hypomagnesemia is also likely to develop, especially in those who misuse diuretics or alcohol, and can work synergistically with hypokalemia to increase the risk for cardiac conduction abnormalities.

Sudden cardiac death

The above discussed complications, including cardiac structural changes, bradyarrhyhmias, electrolyte abnormalities, and conduction abnormalities, can create a perfect storm that increases the risk for sudden cardiac death. Sudden death can be instigated through QT prolongation from electrolytes or medications, from hypoglycemia, or from other causes.

References

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