Cardiovascular Complications of Eating Disorders

What Are Eating Disorders?

Eating disorders are defined as behavioral conditions characterized by severe and ongoing disturbance in eating behaviors, along with the distressing thoughts and feelings accompanying them. These circumstances can adversely affect an individual's physical, mental, and social functioning. Anorexia nervosa, bulimia nervosa, avoidant restrictive food intake disorder, binging eating disorder, pica, and rumination disorder are a few examples of eating disorders.

What Are the Cardiovascular Complications Associated With Eating Disorders?

• Anorexia Nervosa: When a person has anorexia nervosa, they may skip eating altogether, consume very little food overall, or consume only a limited number of specific foods. Additionally, they might continually measure themselves. They might perceive their weight as excessive even when they are critically underweight. A restrictive subgroup and a binge-purge subtype exist within the anorexia nervosa spectrum.

• Restrictive: Individuals with the anorexia nervosa subtype of restrictive drastically restrict their intake of food types and quantities.

Anorexia nervosa patients who suffer from the binge-purge subtype also severely limit the types and quantities of food they ingest. In addition, individuals may experience episodes of binge eating and purging, characterized by the rapid consumption of excessive amounts of food, followed by actions such as induced vomiting or the use of laxatives or diuretics to eliminate the consumed food.

• Bradycardia: Bradycardia is the medical term used to describe an abnormally slow heartbeat characterized by a rate of less than 60 beats per minute. On the contrary, a normal heartbeat typically falls within 60 to 100 beats per minute. Following a significant weight reduction, bradycardia can develop in people with eating disorders. One begins to lose muscle mass as their weight decreases, including the heart muscle. The heart consequently shrinks and loses effectiveness. As a result, the heart muscle slows down because the parasympathetic nervous system needs to preserve energy to keep the rest of the body operating normally. As the heartbeat decreases, the body experiences health issues because the heart cannot return oxygen-rich blood to the body.

• Hypotension: Cardiovascular problems cause roughly one-third of anorexia nervosa patients' fatalities. Anorexia is a significant factor in how eating disorders affect the heart and is frequently considered by doctors and other medical professionals worldwide. Anorexia can lead to arrhythmia or irregular heartbeats at any weight below the optimal body weight. Bradycardia is the most prevalent type, where the body rests at a meager rate of about 60 beats per minute.

• Bulimia Nervosa: Bulimia nervosa is a severe and potentially life-threatening eating disorder in which individuals engage in secretive episodes of binge eating followed by purging as they strive to eliminate the excess calories through unhealthy means. Binge eating is characterized as the consumption of a large quantity of food without the ability to exert control over the eating behavior. After binging or engaging in excessive exercise to drop weight, patients may self-induce vomiting or abuse laxatives, weight loss supplements, diuretics, or enemas. Individuals diagnosed with bulimia nervosa may face long-term risks of cardiovascular diseases, including ischemic cardiac events, conduction abnormalities, and increased mortality rates among females.

• Hypokalemia: Patients who purge are more likely to have electrolyte anomalies, whether they have bulimia nervosa or the binge-purge subtype of anorexia nervosa. Electrolyte anomalies affect 50 % of bulimic patients, with low potassium levels thought to affect 13.7–20 % of purging patients. (hypokalemia). Hypokalemia, a significant complication for patients, can give rise to various cardiac problems, including muscular weakness, disruptions in conduction, and the occurrence of cardiac arrhythmias characterized by irregular heartbeats.

How Do Cardiovascular Problems Affect Eating Disorders?

Patients with severe cardiac complications require treatment in a specialized medical stabilization center, where they receive continuous monitoring and a gradual reintroduction of food to minimize the risks associated with the refeeding syndrome and exacerbation of pre-existing complications. Unlike eating disorder residential treatment programs, medical stabilization programs have the telemetry support required to evaluate symptom progression and improvement and same-day laboratory findings used to track basic electrolyte levels affecting the heart's functionality.

Can Eating Disorders Reverse Heart Conditions?

Many of the cardiac problems brought on by eating habits can be reversed. Following the restoration of weight, most patients will typically observe the resolution of various issues, including bradycardia, hypotension, and hypokalemia. Following weight restoration, many structural anomalies will also get better. However, excess fluid can accumulate in the region surrounding the heart in very few instances of cardiac tamponade. Patients may require an immediate pericardiocentesis, a treatment that drains the extra fluid pressing on the nature and impairing its ability to pump.

What Are the Treatments Available for Eating Disorders?

The type of treatment chosen will rely on the needs of the patient. Depending on their current physical and mental health state, a person may receive therapy through inpatient or outpatient hospitalization. The following methods are typically used in combination with anorexia treatment:

• Psychotherapy: Individual counseling that concentrates on changing a person with an eating disorder's thoughts (cognitive therapy) and behaviors (behavioral therapy) is known as psychotherapy. Practical methods for fostering positive attitudes toward eating and weight, as well as strategies for altering how the patient reacts to trying circumstances, are all included in treatment.

• Medication: The anxiety and sadness that are frequently linked to anorexia may be treated with medication by some healthcare professionals. The antipsychotic drug olanzapine may aid in weight increase. For period regulation, doctors will occasionally recommend it.

• Family counseling or group therapy.

• Hospitalization.

Conclusion:

Anorexia nervosa and bulimia are two eating disorders with the highest mortality rate of any psychiatric condition. Cardiovascular complications like bradycardia, hypotension, and arrhythmia caused by extended QTc intervals and/or electrolyte problems account for this mortality and morbidity. The heart is structurally atrophic in eating disorder individuals, possibly related to chronic hypovolemia.

Despite having hypotension, these patients have poor cardiac output and exhibit higher peripheral vascular resistance. Eating disorders are treated with incremental caloric feeding, which has its own inherent cardiovascular risk (refeeding syndrome) that can appear as arrhythmia, tachycardia, congestive heart failure, and sudden cardiac mortality. Patients will need careful observation and slower feedings to reduce the likelihood of these complications.