Prolonged QT interval in a man with anorexia nervosa

Abstract

Anorexia nervosa is an eating disorder characterized by the avoidance of food intake, which usually leads to a weight loss. Cardiac co-morbility is common and we can find sometimes a mass loss from the left ventricle, which can be seen by echocardiography. But the commonest complications are rhythm variations, typically bradycardia with a prolonged QT interval in up to a 40% of the cases, which altogether elevates ventricular tachycardia and sudden death risk. We present the case of a male who was diagnosed with anorexia nervosa and developed asthenia, a long QT interval and also a severe both hypokalaemia and hypomagnesaemia. We intend to discuss the pathogenic paths as well as prophylactic and therapeutic measures to this potentially-lethal pathology.

Cardiac arrest: first presentation of anorexia nervosa

“…Published case reports include initial presentations with seizures,4 episodes of collapse5 or asthenia,6 but this is the first to describe cardiac arrest as the first presentation of an eating disorder to services.…”

Anorexia Nervosa

“…3,4 This disease is most common in teenage females of western nations. 5 Patients may present with complaints of weakness, weight loss, constipation, syncope, and amenorrhea among other symptoms.…”

“…9,10 This may be due to the use of antidepressants and antipsychotics, as well as hypokalemia and hypomagnesemia from purging and diuretic abuse. 4,7 Other ECG findings include right axis deviation, low QRS amplitude, ST depression, and T wave flattening. 3 Anorexic patients may also have a significant reduction in myocardial mass, which can present as a small heart seen on chest radiography (CXR).…”

Risk for prolonged QT interval and associated outcomes in children with early restrictive eating patterns

“…Prolongation of the QT interval, a marker of abnormal ventricular re-polarisation, has been considered a potential factor in the underlying mechanism of sudden cardiac death in these patients. [5][6][7][8][9] Controversy remains, however, as to the utility of corrected QT (QTc) measurement as a proxy to disease severity and risk of cardiac death, as studies to date have been unable to consistently correlate a QTc threshold with disease progression. 3,8,10,11 Although it has been described that some patients with eating disorders can experience electrolyte abnormalities and loss of cardiac muscle mass, 5,12 whether these factors are directly associated with QTc prolongation or malignant arrhythmias has not been well-demonstrated.…”