Eating disorders are serious mental health conditions that lead to a host of medical complications, negatively impacting physical, social, and psychological health. One of the most common medical complications seen in anorexia nervosa is a slow heart rate, also referred to as sinus bradycardia. Slow heart rate occurs most frequently in individuals with a low body weight and body mass index, but can occur anytime there has been significant weight loss.
Identifying and treating low heart rate in patients with anorexia nervosa is crucial. Research shows at least one-third of deaths in patients with anorexia are due to cardiac issues. When inadequate nutrients are consumed for an extended period of time, structural changes occur to the heart muscle that can lead to a heart attack or sudden cardiac arrest. This can occur in anyone from young athletes to older adults. The good news is that medical professionals are trained in identifying the common warning signs and can provide patients with the necessary medical care to improve heart function and continue on their recovery journey.
What is Anorexia Nervosa?
Anorexia nervosa is a serious eating disorder characterized by abnormally low body weight and body mass index, an intense fear of weight gain, and a distorted perception of body weight and shape. It has the highest mortality rate of all psychiatric disorders. Individuals with anorexia severely restrict the amount of food they consume in an attempt to prevent weight gain.
A subtype of anorexia nervosa, called atypical anorexia has all the symptoms of anorexia except for being underweight. An individual with atypical anorexia may experience significant weight loss and struggles with disordered eating symptoms, but does not meet the diagnostic criteria for low body weight. A common myth in eating disorders is that restrictive diets are only dangerous if the patient is underweight, but this is not true. Anyone who has lost a significant amount of weight or has been depriving themselves of adequate nutrition, despite what their body mass index is, can experience adverse medical complications.
Signs of Anorexia Nervosa
Identifying individuals struggling or at risk with anorexia nervosa can be difficult because many of the restrictive behaviors they engage in are perceived as positive lifestyle choices in our diet centered culture. It is important that if you or someone you love may be struggling with an eating disorder, you reach out to a healthcare provider to receive appropriate medical care. Some of the most common warning signs of anorexia nervosa include:
- Dramatic weight loss
- An unhealthy obsession with food, calories, and nutrition information
- Preoccupation with body weight, shape, and size
- Changes in mood and emotional state
- Refusal to eat once loved foods and/or removal of whole food groups form one’s diet
- Unexplained GI distress presenting as abdominal pain, constipation, and early fullness
- Decreased tolerance for cold weather
- Intense fear of gaining weight Withdrawal from friends, social activities, and hobbies
- Frequent body checking in mirrors and reflective surfaces Anxiety about eating in public
- Denial of hunger and refusal to eat
- Engaging in uncommon food rituals
Common Medical Complications in Anorexia Nervosa
Individuals struggling with an eating disorder unfortunately struggle with numerous health complications. These complications can range from mild to severe. Trained medical professionals can guide you through appropriate medical care. Some of the most common medical complications resulting from anorexia nervosa include:
- Dizziness and fainting
- Orthostatic hypotension
- Loss of menstrual cycle
- Dehydration
- Lanugo Hair – fine, soft hair, that grows on the back and face when someone loses too much body fat. The hair growth is meant to provide an additional layer of warmth
- Significant hair Loss Brittle nails and dry skin
- Osteopenia and Osteoporosis
- Brain atrophy and cognitive deficits
- Cardiac complications
Common Cardiac Complications in Anorexia Nervosa
The human heart muscle requires a significant amount of daily calories to properly function. Without adequate nutrients, the heart muscle begins to atrophy and lose muscle mass. Early intervention is imperative in order to prevent cardiac complications from worsening. Some of the most common cardiac complications seen in anorexia nervosa include:
- Low heart rate (Sinus bradycardia)
- Prolonged QT interval
- Mitral valve prolapse
- Decreased heart muscle mass
- Chest pain
- Irregular heart beat (Cardiac arrhythmia)
- Heart Failure
- Sudden cardiac death
Diagnosis of Low Heart Rate
Low heart rate is one of the most common cardiac complications seen in anorexia nervosa, affecting up to 95% of patients. This is seen most frequently in patients who are less than 80-85% their ideal body weight (IBW). Low heart rate is defined when resting heart rate is less than 60 bpm. For reference, the normal range for a resting heart rate is between 60-100 bpm. When an individual’s resting heart rate drops below 40 bpm, the American Heart Association recommends patients immediately go to the emergency department to receive medical care.
The main cause of low heart rate in anorexia nervosa is inadequate calorie consumption and significant weight loss. This leads to structural changes in the heart, causing it to become less efficient. This occurs because of an increase in the parasympathetic nervous system in an attempt to conserve energy for the rest of the body’s vital functions. As the heart rate continues to slow down, the heart is unable to pump adequate amounts of oxygen and nutrients to the rest of the body.
Signs and Symptoms of Low Heart Rate
Identifying signs and symptoms of low heart rate in individuals struggling with anorexia nervosa is vitally important and can prove to be life saving. The follow symptoms should be taken very seriously:
- Chest Pain
- Shortness of Breath
- Dizziness
- Fainting
- Fatigue
- Confusion or memory problems
As noted earlier, it is important to understand the seriousness of low heart rate in individuals with anorexia and immediately seek appropriate medical care. When a slowed heart rate is accompanied by other medical complications such as ECG abnormalities or other arrhythmias, sudden death can occur. A physical examination to rule out an underlying condition that may be affecting heart health and function can be done by a physician to provide additional information to rule out any other medical issues.
The Good News
There is evidence that bradycardia resulting from anorexia nervosa can be reversible with appropriate nutritional intake and weight restoration. Weight restoration is always one of the primary treatment goals when severe weight loss has occurred and can assist in improving numerous medical conditions associated with anorexia nervosa. A medical professional trained in eating disorders can review the different treatment options available and help determine which level of care is most appropriate. Early intervention is key in not only treating low heart rate, but improving the chances of full recovery from all eating disorders.
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Sources:
https://pubmed.ncbi.nlm.nih.gov/15909184/
https://www.mccallumplace.com/about/blog/cardiovascular-complications-eating-disorders/
https://www.heart.org/en/health-topics/arrhythmia/about-arrhythmia/bradycardia–slow-heart-rate#:~:text=Bradycardia%20is%20a%20heart%20rate,(BPM)%20qualifies%20as%20bradycardia.
https://www.acute.org/resource/bradycardia-anorexia
https://withinhealth.com/learn/articles/how-anorexia-nervosa-can-affect-heart-rates
