Weight Loss and the Heart

TLDR

Anorexia nervosa, a prevalent psychiatric disorder in young women, leads to cardiovascular complications such as rhythm disturbances, valve prolapse, ventricular dysfunction, and reduced exercise capacity, while protein‑calorie malnutrition worldwide can similarly cause ventricular dysfunction and heart failure during refeeding. A high level of suspicion for cardiovascular complications is warranted in evaluating and treating weight loss conditions such as starvation and anorexia nervosa.

Abstract

Anorexia nervosa is a common psychiatric disorder predominantly affecting young women, associated with significant morbidity and mortality, much involving the cardiovascular system. In contrast, protein-calorie malnutrition, while not strictly analogous to the protein-sparing characteristics often noted in anorexia nervosa, is a problem of global stature. Physiologic consequences of anorexia nervosa include rhythm disturbances, mitral valve prolapse, plus both systolic and diastolic ventricular dysfunction. Diminished exercise capacity occurs in both states, with marked blunting of the heart rate and blood pressure response. Congestive heart failure may appear, especially during refeeding. In addition to the myofibrillar destruction associated with protein-calorie malnutrition, hypophosphatemia, particularly when exacerbated by unrestricted glucose-rich refeedings or hyperalimentation, may be one additional cause of ventricular dysfunction. A high level of suspicion for cardiovascular complications is, therefore, warranted in the evaluation and therapy of weight loss conditions such as starvation and anorexia nervosa.