Reprinted from Eating Disorders Review
July/August 1999 Volume 10, Number 4
©1999 Gürze Books
The first surprise researchers at the University of British Columbia encountered was finding that chest pain is so common among patients with anorexia nervosa. Their search of the literature from 1966 to 1996 showed that 87% of anorexia nervosa patients had experienced chest pain. Their next surprise was that no explanation for the chest pain was given for 38% of patients (Int J Eat Disord 25:219-222, 1999). The researchers also found that typical and atypical angina are surprisingly common among women with AN; the incidence was 11% and 9%, respectively.
Dr. C. Laird Birmingham and his colleagues note that chest pain felt by AN patients, particularly typical and atypical angina, might be due to ischemic heart disease. These patients are at increased risk of coronary artery disease (CAD). Major risk factors are presence of typical angina, postmenopausal status without hormone replacement therapy, diabetes mellitus, and peripheral vascular disease. Smokers, women with low high-density lipoprotein cholesterol levels and high total cholesterol (>6.85 mmol/l) also have a higher risk of CAD. The authors recommend that all patients with eating disorders be screened with a thorough history for chest pain, and other risks for CAD.
QTC interval changes
Swedish researchers have concluded that ECG exams are an essential part of assessment of patients with eating disorders and continuing weight loss, even if no electrolyte disturbances are found (Acta Pediatr 88:304, 1999). This recommendation is especially important if the patient is severely underweight or is rapidly losing weight, according to Drs. I. Swenne and P.T. Larrson of Uppsala University Children’s Hospital.
In a study of 58 teenaged girls with anorexia nervosa (mean age: 15.5), the scientists investigated risk factors for QTc interval prolongation and dispersion, two indicators of an increased risk for cardiac arrhythmias and sudden death. The patients weighed 40.7 kg, and had lost a mean of 11.8 kg. This group was compared with 38 normal-weight teenaged girls with no known heart disease.
ECG studies of the anorexic patients showed bradycardia, a shift to the right of the QRS axis, diminished amplitudes of the QRS complex and T wave, and prolonged and increased dispersion of the QTc interval. The most important predictors of the QTC abnormalities were low weight, low BMI, and rapid weight loss immediately before the examination.