REVIEW PAPER
Cardiovascular complications in children and adolescents
with anorexia
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1
Central Clinical Hospital of the Ministry of the Interior and Administration, Warsaw, Poland
2
St. Anna’s Hospital of Trauma Surgery, Warsaw, Poland
Submission date: 2022-05-31
Final revision date: 2022-07-26
Acceptance date: 2022-08-06
Publication date: 2022-12-30
Pediatr Pol 2022;97(4):337-342
KEYWORDS
TOPICS
ABSTRACT
Anorexia nervosa is a major public health problem that affects people of all ages, including children. Eating disorders can lead to many complications, one of the most serious of which are heart disorders. This article aimed to discuss the large scale of anorexia among children and adolescents, the most common cardiological complications, and presentation of a practical approach to the problem. For this purpose, a comprehensive review of the literature was conducted. The described cardiological complications in anorexics are as follows: arrhythmias, mitral valve prolapse, pericardial effusion, congestive heart failure, myocardial infarction, and Takotsubo cardiomyopathy. According to existing studies, it is essential to react quickly in the event of diagnosing an eating disorder among adolescents. Observation of the patient for cardiac complications is very important for saving the health of a child with anorexia nervosa. Children with eating disorders require long-term care, involving many people like doctors, psychologists, and parents.
REFERENCES (60)
1.
Keski-Rahkonen A, Hoek HW, Susser ES, et al. Epidemiology and course of anorexia nervosa in the community. Am J Psychiatry 2007; 164: 1259-1265.
2.
Fairburn CG, Harrison PJ. Eating disorders. Lancet 2003; 361: 407-416.
3.
Treasure J, Duarte TA, Schmidt U. Eating disorders. Lancet 2020; 395: 899-911.
4.
Casiero D, Frishman WH. Cardiovascular complications of eating disorders. Cardiol Rev 2006; 14: 227-231.
5.
Giovinazzo S, Sukkar SG, Rosa GM, et al. Anorexia nervosa and heart disease: a systematic review. Eat Weight Disord 2019; 24: 199-207.
6.
Portilla MG. Bradycardia: an important physical finding in anorexia nervosa. J Ark Med Soc 2011; 107: 206-208.
7.
Neumärker KJ. Mortality and sudden death in anorexia nervosa. Int J Eat Disord 1997; 21: 205-212.
8.
Crisp AH, Callender JS, Halek C, Hsu LK. Long-term mortality in anorexia nervosa. A 20-year follow-up of the St. George’s and Aberdeen cohorts. Br J Psychiatry 1992; 161 :104-107.
9.
Marzec I, Zabłocka K, Stachurski J. Suicide attempts in children and adolescents – risk factors, methods and management of suicidal patient. Ped Pol 2021; 96: 1-8.
10.
Spaulding-Barclay MA, Stern J, Mehler PS. Cardiac changes in anorexia nervosa. Cardiol Young 2016; 26: 623-628.
11.
Sekaninova N, Bona Olexova L, Visnovcova Z, Ondrejka I, Tonhajzerova I. Role of neuroendocrine, immune, and autonomic nervous system in anorexia nervosa-linked cardiovascular diseases. Int J Mol Sci 2020; 21: 7302.
12.
Hoek HW, van Hoeken D. Review of the prevalence and incidence of eating disorders. Int J Eat Disord 2003; 34: 383-396.
13.
Oflaz S, Yucel B, Oz F, et al. Assessment of myocardial damage by cardiac MRI in patients with anorexia nervosa. Int J Eat Disord 2013; 46: 862-866.
14.
Facchini M, Sala L, Malfatto G, Bragato R, Redaelli G, Invitti C. Low-K+ dependent QT prolongation and risk for ventricular arrhythmia in anorexia nervosa. Int J Cardiol 2006; 106: 170-176.
15.
Solomon CG, Hu FB, Dunaif A, et al. Menstrual cycle irregularity and risk for future cardiovascular disease. J Clin Endocrinol Metab 2002; 87: 2013-2017.
16.
Dalton B, Whitmore V, Patsalos O, Ibrahim MAA, Schmidt U, Himmerich H. A systematic review of in vitro cytokine production in eating disorders. Mol Cell Endocrinol 2019; 497: 110308.
17.
Glezeva N, Baugh JA. Role of inflammation in the pathogenesis of heart failure with preserved ejection fraction and its potential as a therapeutic target. Heart Fail Rev 2014; 19: 681-694.
18.
Jenkins ZM, Eikelis N, Phillipou A, Castle DJ, Wilding HE, Lambert EA. Autonomic nervous system function in anorexia nervosa: a systematic review. Front Neurosci 2021; 15: 682208.
19.
Cotter R, Lyden J, Mehler PS, Miceli J, Schuller J, Krantz MJ. A case series of profound bradycardia in patients with severe anorexia nervosa: thou shall not pace? HeartRhythm Case Rep 2019; 5: 511-515.
20.
Kusumoto FM, Schoenfeld MH, Barrett C, et al. 2018 ACC/AHA/HRS guideline on the evaluation and management of patients with bradycardia and cardiac conduction delay: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol 2019; 74: e51-e156.
21.
Yahalom M, Spitz M, Sandler L, Heno N, Roguin N, Turgeman Y. The significance of bradycardia in anorexia nervosa. Int J Angiol 2013; 22: 83-94.
22.
Shamim T, Golden NH, Arden M, Filiberto L, Shenker IR. Resolution of vital sign instability: an objective measure of medical stability in anorexia nervosa. J Adolesc Health 2003; 32: 73-77.
23.
Poghosyan HR, Danoyan AB, Hovakimyan TB, Kartoyan ZE, Davtyan KV. Cardiogenic anorexia and underweighting in a child: case report. Eur Heart J Case Rep 2018; 2: yty047.
24.
Janzen ML, Malhi N, Laksman ZWM, Puyat J, Krahn AD, Hawkins NM. The QT interval in anorexia nervosa: a meta-analysis. JACC Clin Electrophysiol 2018; 4: 839-841.
25.
Johnson JN, Ackerman MJ. QTc: how long is too long? Br J Sports Med 2009; 43: 657-662.
26.
Van Aerde KJ, Kalverdijk LJ, Reimer AG, Widdershoven JA. [QT interval prolongation and psychotropic drugs in children and adolescents: proposed guideline]. Ned Tijdschr Geneeskd 2008; 152: 1765-1770.
27.
Kanbur NO, Goldberg E, Pinhas L, Hamilton RM, Clegg R, Katzman DK. Second-degree atrioventricular block (Mobitz Type I) in an adolescent with anorexia nervosa: intrinsic or acquired conduction abnormality. Int J Eat Disord 2009; 42: 575-578.
28.
Meyers DG, Starke H, Pearson PH, Wilken MK. Mitral valve prolapse in anorexia nervosa. Ann Intern Med 1986; 105: 384-386.
29.
Mack MJ. Risk assessment for valvular heart disease. Valvular heart disease: a companion to braunwald’s heart disease. E-Book, 2014; 3: 134.
30.
Cheng TO. Anorexia nervosa and the heart. Lancet 1988; 1: 1225.
31.
Cheng TO. Preventing mitral valve prolapse in anorexia nervosa. CMAJ 1989; 141: 192-193.
32.
Cheng TO. [Mitral valve prolapse is a frequent cardiovascular finding in patients with anorexia nervosa]. Rev Esp Cardiol 2003; 56: 1246.
33.
Johnson GL, Humphries LL, Shirley PB, Mazzoleni A, Noonan JA. Mitral valve prolapse in patients with anorexia nervosa and bulimia. Arch Intern Med 1986; 146: 1525-1529.
34.
Carlomagno G, Mercurio V, Ruvolo A, et al. Endocrine alterations are the main determinants of cardiac remodelling in restrictive anorexia nervosa. ISRN Endocrinol 2011; 2011: 171460.
35.
Zastrow A, Wolf J, Giannitsis E, et al. Elevated myocardial enzymes and natriuretic peptides in anorexia nervosa: prototypic condition for the pathophysiology of cachexia? Cardiology 2011; 118: 256-259.
36.
Docx MK, Gewillig M, Simons A, et al. Pericardial effusions in adolescent girls with anorexia nervosa: clinical course and risk factors. Eat Disord 2010; 18: 218-225.
37.
Docx MKF, Paelinck BP. Huge pericardial effusion with subcutaneous emphysema, pneumomediastinum and pneumopericardium in anorexia nervosa. Acta Cardiol 2018; 73: 293-294.
38.
Polli N, Blengino S, Moro M, Zappulli D, Scacchi M, Cavagnini F. Pericardial effusion requiring pericardiocentesis in a girl with anorexia nervosa. Int J Eat Disord 2006; 39: 609-611.
39.
Katz AM, Rolett EL. Heart failure: when form fails to follow function. Eur Heart J 2016; 37: 449-454.
40.
Powers PS. Heart failure during treatment of anorexia nervosa. Am J Psychiatry 1982; 139: 1167-1170.
41.
Birmingham CL, Gritzner S. Heart failure in anorexia nervosa: case report and review of the literature. Eat Weight Disord 2007; 12: e7-10.
42.
Lesinskiene S, Barkus A, Ranceva N, Dembinskas A. A meta-analysis of heart rate and QT interval alteration in anorexia nervosa. World J Biol Psychiatry 2008; 9: 86-91.
43.
Winston AP, Jamieson CP, Madira W, Gatward NM, Palmer RL. Prevalence of thiamin deficiency in anorexia nervosa. Int J Eat Disord 2000; 28: 451-454.
44.
Davidson A, Anisman PC, Eshaghpour E. Heart failure secondary to hypomagnesemia in anorexia nervosa. Pediatr Cardiol 1992; 13: 241-242.
45.
Cariem AK, Lemmer ER, Adams MG, Winter TA, O’Keefe SJ. Severe hypophosphataemia in anorexia nervosa. Postgrad Med J 1994; 70: 825-827.
46.
Ohwada R, Hotta M, Kimura H, et al. Ampulla cardiomyopathy after hypoglycemia in three young female patients with anorexia nervosa. Intern Med 2005; 44: 228-233.
47.
Bonnemeier H, Mall G, Wiegand UK. Sudden cardiac death due to catecholamine cardiomyopathy in anorexia nervosa. Resuscitation 2006; 68: 9-10.
48.
García-Rubira JC, Hidalgo R, Gómez-Barrado JJ, Romero D, Cruz Fernández JM. Anorexia nervosa and myocardial infarction. Int J Cardiol 1994; 45: 138-140.
49.
Abuzeid W, Glover C. Acute myocardial infarction and anorexia nervosa. Int J Eat Disord 2011; 44: 473-476.
50.
Volman MN, Ten Kate RW, Tukkie R. Tako Tsubo cardiomyopathy, presenting with cardiogenic shock in a 24-year-old patient with anorexia nervosa. Neth J Med 2011; 69: 129-131.
51.
Amin HZ, Amin LZ, Pradipta A. Takotsubo cardiomyopathy: a brief review. J Med Life 2020; 13: 3-7.
52.
Rotondi F, Manganelli F, Lanzillo T, et al. Tako-tsubo cardiomyopathy complicated by recurrent torsade de pointes in a patient with anorexia nervosa. Intern Med 2010; 49: 1133-1137.
53.
Kikuchi K, Yasui-Furukori N, Hasegawa C, Watahiki M, Inoue T, Shimoda K. Takotsubo cardiomyopathy after hypoglycemia in a patient with anorexia nervosa. Ann Gen Psychiatry 2021; 20: 39.
54.
Egedal JM, Carter-Storch R, Støving RK. [Takotsubo cardiomyopathy as a result of refeeding syndrome in a patient with anorexia nervosa]. Ugeskr Laeger 2021; 183: V01210093.
55.
Zalewska-Adamiec M, Malyszko J, Bachórzewska-Gajewska H, Tomaszuk-Kazberuk A, Dobrzycki SJ. Takotsubo syndrome – fatal prognosis of patients with low body mass index in 5-year follow-up. Arch Med Sci 2020; 16: 282-288.
56.
Hudson LD, Cumby C, Klaber RE, Nicholls DE, Winyard PJ, Viner RM. Low levels of knowledge on the assessment of underweight in children and adolescents among middle-grade doctors in England and Wales. Arch Dis Child 2013; 98: 309-311.
57.
Miller KK, Grinspoon SK, Ciampa J, Hier J, Herzog D, Klibanski A. Medical findings in outpatients with anorexia nervosa. Arch Intern Med 2005; 165: 561-566.
58.
Mehler PS, Krantz MJ, Sachs KV. Treatments of medical complications of anorexia nervosa and bulimia nervosa. J Eat Disord 2015; 3: 15.
59.
Hernandez LE. Takotsubo cardiomyopathy: how much do we know of this syndrome in children and young adults? Cardiol Young 2014; 24: 580-592.
60.
Harrington BC, Jimerson M, Haxton C, Jimerson DC. Initial evaluation, diagnosis, and treatment of anorexia nervosa and bulimia nervosa. Am Fam Physician 2015; 91: 46-52.