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Can anorexia cause heart problems?

Eating disorders like anorexia nervosa (AN) are mental health conditions, but they can result in a number of physical complications.

Severely restricting dietary and caloric intake, as is nearly always the case with AN, can lead to low body weight, malnutrition, and a loss of muscle mass.

In the heart, this could lead to both high and low heart rate and other medical complications that can cause further heart damage, or even sudden cardiac arrest. Still, early intervention and effective treatment can help reverse these effects and restore heart health and overall mental and physical wellness.

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Last updated on 
August 3, 2023
August 3, 2023
In this article

Anorexia nervosa and the heart

The extreme restriction involved with anorexia nervosa can lead to heart beat irregularities (arrhythmia) and other heart damage in several ways.

The dearth of calories can lead to the loss of muscle mass, including within the heart, which can negatively affect the way the heart functions. Dietary restrictions can also lead to nutritional deficiencies and electrolyte imbalances, which can severely impact heart rhythms.

Specifically, the cardiovascular complications a person who has AN can experience include:1,2,3,5
  • Dangerously low heart rate (bradycardia)
  • Precipitously high heart rate (tachycardia)
  • Heart attack
  • Low blood pressure (hypotension)
  • Heart palpitations
  • Fluid retention in the heart (pericardial effusion)
  • Heart failure or sudden death

This range of potential cardiac issues is part of why AN has the highest mortality rate among all eating disorders. (1)

Anorexia and low heart rates 

When the heart rate is persistently low, it's called bradycardic. And this issue is especially common in patients with AN, with various studies finding bradycardia anorexia in up to 41% of hospitalized patients, and hypotension in 16% of patients. (6,7) 

Low heart rate with anorexia nervosa is most often connected to severe weight loss, which can cause significant changes to metabolism and disrupt electrolyte balance. Overall, most studies show that cardiac changes ensue when someone dips below 80%-85% of their ideal body weight. (3, 5)

The heart must pump so many times per minute and create a high enough blood pressure to send blood to vital organs and tissues throughout the body. When the heart rate is too low, blood can not circulate throughout the entire body. This can lead to tissue and organ damage and, in severe and prolonged cases, organ failure. (3)

Happily, it is possible to improve heart rate and heart muscle with healthy weight restoration, though this process can be dangerous, and should be done under the direct supervision of a physician. When the body lives in a state of severe starvation for a long time, it undergoes major changes to conserve energy. The sudden consumption of calories again can throw this new system into disarray, causing electrolyte imbalance that can lead to a potentially deadly condition called refeeding syndrome. (13)

doctor reviewing chart

Anorexia and high heart rates

It's also possible for anorexia nervosa to lead to a high heart rate, called tachycardia.

While low heart rate with anorexia nervosa is usually an adapted response to prolonged starvation and negative energy balance, tachycardia is more usually connected to nutritional deficiencies.

Severe iron deficiency (anemia) is one of the most common issues that can lead to a high heart rate. It's also possible for someone to develop high heart rate due to infection, which people with AN are more susceptible to, due to a lack of adequate nourishment. (12) In fact, when someone with AN develops a resting high heart rate, it's often recommended to investigate for the infectious cause. (12)

This type of arrhythmia can also increase the risk of heart attack. When electrolyte abnormalities, which commonly result from improper nutrition, come into play, it often leads to severe cardiac episodes. (11)

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Other heart issues caused by anorexia nervosa

Slow heart rate and fast heart rate are not the only cardiac complications connected to anorexia nervosa.

Mitral valve prolapse (MVP)
Pericardial effusions
Heart failure
researching medical issues

Finding help for anorexia nervosa

If you or a loved one are struggling with an intense fear of gaining weight, severely limited dietary intake, or other symptoms of anorexia nervosa or another eating disorder, it's highly recommended to seek out help.

Speaking with your healthcare provider can be especially helpful if you have concerns regarding your heart rate. But the faster you seek out help, the better. Eating disorders, and their related medical issues, don't go away on their own, and they tend to get worse as time goes on.

Our team at Within Health can help with the treatment of anorexia nervosa or other eating disorders.

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Disclaimer about "overeating": Within Health hesitatingly uses the word "overeating" because it is the term currently associated with this condition in society, however, we believe it inherently overlooks the various psychological aspects of this condition which are often interconnected with internalized diet culture, and a restrictive mindset about food. For the remainder of this piece, we will therefore be putting "overeating" in quotations to recognize that the diagnosis itself pathologizes behavior that is potentially hardwired and adaptive to a restrictive mindset.

Disclaimer about weight loss drugs: Within does not endorse the use of any weight loss drug or behavior and seeks to provide education on the insidious nature of diet culture. We understand the complex nature of disordered eating and eating disorders and strongly encourage anyone engaging in these behaviors to reach out for help as soon as possible. No statement should be taken as healthcare advice. All healthcare decisions should be made with your individual healthcare provider.

Resources

  1. Yahalom, M., Spitz, M., Sandler, L., et al. (2013). The Significance of Bradycardia in Anorexia Nervosa. International Journal of Angiology, 22(02), 83-94.
  2. Portilla, M. G. (2011). Bradycardia: an important physical finding in anorexia nervosa. J Arkansas Med Soc, 107(10), 206-208. 
  3. Mehler, P. Anorexia nervosa in adults and adolescents: Medical complications and their management. UpToDate. Article last updated: 7 April, 2021. Accessed 28 Jan, 2022. 
  4. Mehler P. S., Krantz, M. (2003). Anorexia nervosa medical issues. Journal of Women’s Health, 12(4), 331. 
  5. Krantz, M., Mehler, P. (2004). Resting tachycardia, a warning sign in anorexia nervosa: case report. BMC Cardiovasc Disord, 4, 10.
  6. Mehler, P. S., Blalock, D. V., Walden, K., Kaur, S., McBride, J., Walsh, K., & Watts, J. (2018). Medical findings in 1,026 consecutive adult inpatient-residential eating disordered patients. The International Journal of Eating Disorders, 51(4): 305–313.
  7. Miller, K. K., Grinspoon, S. K., Ciampa, J., Hier, J., Herzog, D., & Klibanski, A. (2005). Medical findings in outpatients with anorexia nervosa. Archives of Internal Medicine, 165(5), 561–566.
  8. Cheng, T. (2003). Mitral Valve Prolapse is a Frequent Cardiovascular Finding in Patients With Anorexia Nervosa. Rev Esp Cardiol, 56(12), 1246-71.
  9. Freed, L. A., Levy, D., Levine, R. A., Larson, M. G., Evans, J. C., Fuller, D. L., Lehman, B., & Benjamin, E. J. (1999). Prevalence and clinical outcome of mitral-valve prolapse. The New England Journal of Medicine, 341(1), 1–7.
  10. Giovinazzo, S., Sukkar, S. G., Rosa, G. M. et al. (2019). Anorexia nervosa and heart disease: a systematic review. Eating and Weight Disorders, 24, 199–207.
  11. Heart arrhythmia. (n.d.). Mayo Clinic. Accessed August 2023. 
  12. Krantz, M. J., & Mehler, P. S. (2004). Resting tachycardia, a warning sign in anorexia nervosa: case report. BMC Cardiovascular Disorders, 4, 10.
  13. Persaud-Sharma, D., Saha, S., Trippensee, A. (2022). Refeeding Syndrome. StatPearls. Accessed August 2023. 
  14. How your heart works. (n.d.). British Heart Foundation. Accessed August 2023. 
  15. Pericardial Effusion. (n.d.). Cedars Sinai. Accessed August 2023.
  16. Schwinger, R. H., & Erdmann, E. (1992). Heart failure and electrolyte disturbances. Methods and Findings in Experimental and Clinical Pharmacology, 14(4), 315–325.

FAQs

Can anorexia cause a heart attack?

Yes. Anorexia nervosa can lead to various types of arrhythmia and electrolyte imbalances, which can all contribute to a heart attack. Refeeding after prolonged periods of AN can also potentially lead to cardiac arrest.

Can your heart recover after anorexia?

Yes. Many studies have shown that heart damage can be reversed with healthy and sustained weight restoration. This may not be the case in all scenarios, however. The longer someone battles with AN, the likelier they will suffer significant damage, which is why it's important to seek out help as quickly as possible.

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