1. Long-Term Prognosis in Anorexia Nervosa The cardiovascular implications during refeeding and after weight recovery Mary Carter

2. Anorexia Nervosa (AN) Is a life-threatening illness which can be accompanied by cardiac symptoms of varying severity. Eighty percent of patients with an eating disorder are effected by a cardiac complication. It has been reported that approximately one third of deaths are due to cardiac complications.

3. Some cardiac complications Sinus Bradycardia Hypotension Increased Vagal Tone Decreased Voltage and QT Interval Prolongation Diminished Wall Thickness Reduced Cardiac Output

4. During Refeeding Experimental evidence in animals suggests that decreased compliance and diminished systolic contractility persists. Myofibrillar destruction and edema observed in clinical and experimental starvation offers one explanation for decreased ventricular compliance.

5. Refeeding Syndrome Accounts for the cardiovascular decompensation seen during therapy. It is a known complication of parenteral hyperalimentation. Hyperalimentation produces striking hypophosphatemia. – Phosphate depletion produces wide-spread abnormalities at the cellular level.

6. Weight Recovery Patients showed a significant decrease in QT interval (p<.05), and QT dispersion (p<.01) Electrocardiograms showed an increase in cardiac diameters (p<.01), left ventricular mass (p<.001), and cardiac output (p<.001). Exercise capacity improved (0<.05) And there was a normalization of heart rate and heart rate variability (p<.05).

7. References Mont, Louis, et al, “Reversibility of Cardiac Abnormalities in Adolescents With Anorexia Nervosa After Weight Recovery, Journal of American Academy of Child Psychiatry, 42:7, July, 2003. Schochen, Douglas, et al, “Weight Loss and the Heart: Effects of AN and Starvation”, Archives of Internal Medicine, Vol. 149, April 1989.