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Anorexia: life-threatening to the heart.

ANOREXIA: LIFE-THREATENING TO THE HEART

The effects of weight loss on the hearts of young women with the eating disorder anorexia nervosa include a slow heartbeat, low blood pressure, and a decreased heart size--basically almost the same effects seen in those who have suffered starvation.

Dr. Douglas Schocken of the University of South Florida College of Medicinein Tampa, together with colleagues from the school's Center for Eating Disorders, cardiology division, and psychiatry and behavioral medicine department, reviewed reports on the cardiovascular complications of anorexia, a common psychiatric disorder that predominantly affects young women. They point out that the "complications of semi-starvation, particularly cardiac complications, likely account for most deaths associated with anorexia." In fact, mortality has been documented to be as high as 15-20 percent among anorexics followed for 15 years.

The researchers found that anorexics suffer from problems with their heart ventricles, the lower heart chambers that pump blood into the arteries, as well as "mitral valve prolapse," a serious heart-valve condition marked by difficulty in breathing, chest pain and other symptoms. Anorexics must also cope with diminished supplies of glycogen, a substance essential for muscle function, leading to a lack of desire, not to mention ability, to perform physical tasks, including exercise. Finally, if potassium levels get too low, as they often do in anorexics, the heart's rhythm can be destroyed. If that happens, death is the result.

So why not just stuff 'em and send 'em on their way? Bad move, say Schockenand his associates. Too many calories in an already paper-fragile cardiovascular system can kill the anorexic, even if she is fed intravenously (the Schocken team refers to the classic "refeeding syndrome" employed after World War II when concentration-camp survivors were fed more than they could handle and subsequently died). When the body is denied food, it becomes aggravated by the subsequent loss of blood phosphate; this is why starvation victims are usually fed liquids with a small amount of bulk to them, such as milk.

Concluding that more patient studies are needed to "define better the full effects of anorexia nervosa and starvation on the heart and to determine the ideal method of nutritional rehabilitaion," the researchers add: "With the increasing incidence of anorexia nervosa, the breadth and gravity of its cardiac complications should be recognized." They stress that during the evaluation and treatment of anorexics, a high degree of suspicion for cardiovascular complications is warranted. (Archives of Internal Medicine, April 1989; 149:877-881.)
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Title Annotation:slow heartbeat, low blood pressure, decreased heart size
Publication:Medical Update
Date:Jul 1, 1989
Words:409
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