What is the most common cardiovascular complication of anorexia nervosa?

From the Guidelines

The most common cardiovascular complication of anorexia nervosa is mitral valve prolapse. This condition is often seen in patients with anorexia nervosa due to the significant weight loss and malnutrition associated with the disorder. According to the study by 1, mitral valve prolapse is one of the cardiac manifestations of anorexia nervosa, which can be completely reversible by appropriate re-feeding. Some key points to consider in the management of anorexia nervosa include:

• The importance of avoiding very low calorie, semistarvation diets, especially in those with underlying cardiac abnormalities, as they can cause cardiac arrhythmias and sudden cardiac death 1.
• The need for medical monitoring of heart rate, blood pressure, and electrocardiograms during treatment of patients with anorexia nervosa, as cardiac complications can be life-threatening but are often reversible with appropriate nutritional rehabilitation and weight restoration.
• The risk of QT interval prolongation, which increases the risk of dangerous arrhythmias, and is more likely to occur in patients with low weight, low body mass index, and rapid weight loss immediately preceding assessment 1.
• The potential for cardiac muscle atrophy and pericardial effusions due to prolonged periods of starvation, which can further increase the risk of cardiac complications 1.

From the Research

Cardiovascular Complications of Anorexia Nervosa

The patient's symptoms, including weight loss, restricted eating habits, fatigue, lack of energy, and lightheadedness, are consistent with a diagnosis of anorexia nervosa. The most common cardiovascular complication of anorexia nervosa is:

• Mitral valve prolapse, which has been observed in several studies to be frequently associated with anorexia nervosa 2, 3, 4, 5

Prevalence of Mitral Valve Prolapse

The prevalence of mitral valve prolapse in patients with anorexia nervosa has been reported to be:

• 74% in a study of 19 women with anorexia nervosa 2
• 82.6% in a study of 23 patients with anorexia nervosa 3
• 37% in a study of 43 individuals with eating disorders, including anorexia nervosa and bulimia 5

Association with Anorexia Nervosa

The association between mitral valve prolapse and anorexia nervosa is thought to be related to:

• Low body weight and skeletal abnormalities 2, 3
• Autonomic dysfunctions, including an increase in vagal tone 3
• Physiologic changes in cardiac status related to weight loss, rather than central nervous system changes associated with anxiety disorders 4