Anorexia nervosa and second-degree atrioventricular block (Type I)

Heart and anorexia nervosa

Anorexia nervosa, one of the more frequent and severe eating disorders, is a chronic psychiatric disease with potentially serious somatic consequences. This behavioral symptomatology leads to weight loss, undernutrition, and more or less severe-potentially life-threatening-somatic complications including respiratory, hepatic, digestive and cardiac features, electrolyte disturbances, endocrine and bone impairment, immunodepression, and related opportunistic infections. In this review, the authors report an overview of cardiac diseases in this disease.

Cardiogenic anorexia and underweighting in a child: case report

Introduction

In this case, we present a child with a diagnosis of anorexia and no known cardiac disease, who was referred to our clinic for a routine cardiac monitoring. ‘Asymptomatic’ high degree of atrioventricular block (AVB) was revealed. She underwent successful pacemaker (PM) implantation and losing of the weight stopped.

Case presentation

In this case, the abrupt AVB with more than 6 s ventricular pauses without escape rhythm during the day-time most possible is a type of neurally mediated AVB which was presented by anorexia, underweighting, and refusing to eat in a 12-year-old girl. All symptoms disappeared after PM implantation, and weight gain was recorded during 6 months of follow-up.

Discussion

The causal link between AVB and anorexia is discussed. In this case, patient’s eating disorder was related to her AV conduction abnormality. The main reason of this case report is to emphasize, that in children with unexplained anorexia and underweighting cardiogenic origin must be excluded.

Cardiovascular disorders in anorexia nervosa and potential therapeutic targets

Anorexia nervosa (AN) is an eating disorder in which a distorted self-perception of body image and an excessive fear of gaining weight result in extreme restrictions in eating habits. AN may be divided into two types: a "binge-eating/purging type" during which the individual regularly engages in overeating and then purging behavior, and a "restricting type", in which she does not. AN is a serious medical problem in young people in Western societies. It is widely reported that patients with AN exhibit an enhanced mortality rate as compared with age-matched healthy subjects, which has been mainly ascribed to cardiac complications. At least one-third of all deaths in patients with anorexia nervosa are estimated to be due to cardiac causes, mainly sudden death. Cardiovascular complications of AN can be present in up to 80% of cases, and among them alterations in cardiac electrical activity, structure and hemodynamics have been reported as causes of morbidity and mortality. The objective of this brief review is to summarize current knowledge on the main cardiovascular complications of AN, their underlying mechanisms and the possible therapeutic approaches.

Intermittent Brugada syndrome in an anorexic adolescent girl

We report an anorexic adolescent girl with an intermittent Brugada syndrome. A 14-year-old anorexic girl with a body mass index (BMI) of 13.15 kg/m² was admitted in the acute state of the disease with an ST elevation in V1 and V2, suggestive of Brugada syndrome. After 1 month of re-feeding, a control electrograph (ECG) was normal, but after an 8-month follow-up control with a nearly normal BMI, the ECG was again suggestive of Brugada syndrome. A genetic analysis of the gene SNC5A established a genetic change (p Leu 1582 pro), which provides the final explanation for the Brugada syndrome. Every rhythm problem in the acute state or during the re-feeding procedure deserves a strict follow-up to distinguish iatrogenic from heritable rhythm problems. <Learning objective: (i) We report the first case of a patient with anorexia nervosa with an intermittent Brugada syndrome. (ii) Moderate hypothermia can decrease the depolarization of pacemaker cells and cause ST-segment changes. (iii) Every rhythm problem in the acute state or during the re-feeding procedure deserves a strict follow-up to distinguish iatrogenic from heritable rhythm problems. (iv) A genetic analysis can make the distinction and is necessary to give advice for the future lifestyle of the patient.>.

Second-degree atrioventricular block (Mobitz Type I) in an adolescent with anorexia nervosa: intrinsic or acquired conduction abnormality

Anorexia nervosa (AN) can cause both functional and structural cardiac complications, including a variety of different conduction abnormalities. This is the first case report of symptomatic diurnal second-degree atrioventricular (AV) block (Mobitz Type I) in an adolescent with AN. We present a 12-year-old girl with AN, restrictor sub-type who reported cardiac symptoms during weight gain, at the time of the initial diagnosis of AV block. Second-degree AV block (Mobitz Type I) is discussed as a possible complication of the AN, as well as being an intrinsic conduction system disease.

Comparative study of rate of weight loss among premorbid and healthy restrictive eaters

Initial body mass index (BMI) and rate of weight loss are compared between cohorts of pathological and healthy dieters. The eating disordered sample consists of young adults reported in case studies in the past ten years with a primary diagnosis of anorexia nervosa (AN). The healthy dieters were adolescents who participated in the National Longitudinal Survey of Adolescent Health and indicated at the time of study enrollment that they were trying to lose weight. At diet initiation, the anorexic sample had a mean BMI (kg/m2) of 20.5 while the healthy dieters had a mean of 24.8. The median rate of weight loss was -1.87 kg per month (1 pound per week) for individuals later diagnosed with AN, while the median weight change was 0.24 kg per month for the Add Health dieters, reflecting an actual gain of 0.13 pounds per week. These findings suggest that measurable physiological characteristics during the early phase of a diet could be predictive of pathological food restriction.

Recovery from lethal arrhythmia after weight gain in a patient with an eating disorder and epilepsy

We report a 13-year-old girl with epilepsy who experienced syncope after rapid weight loss due to an eating disorder. She developed a lethal (atrioventricular block) arrhythmia, which improved after weight gain. This case suggests that energy depletion might be involved in lethal arrhythmia.