Cardiological and other somatic complications of anorexia nervosa
Keywords:
anorexia nervosa, arrhythmiasAbstract
Anorexia nervosa (AN) is a serious medical condition, very frequently putting patients’ life at risk. The disease manifests itself through striving to lose weight. People affected with it, tend to strive for weight norms not suitable for their age or height. Other than that, such individuals tend to incorrectly assess their body and show huge fear of gaining weight. Starving may lead to impairment of digestive system function, as well as that of endocrines and integuments. Neurotransmission, water and electrolyte balance, and cell metabolism, are also exposed to damage. There is a decrease of certain hormones concentration in the adipose tissue, such as leptin, resistin, vistatin, apelin (APE-36, APE-12) and bone markers: osteocalcin and C-terminal cross-linked telopeptide of type I collagen a chain and the increase of concentration of adiponectin were also described in the patients. Patients affected with AN tend to demonstrate general, physical changes in the cardio-vascular system, resulting from fasting, vomiting and considerable weight loss, leading to electrolyte disorders, arrhythmia, hypotension, bradycardia, peripheral oedema and acrocyanosis.
The changes recorded in ECG, such as ST segment depression, T-wave reversal, T-wave flattering, incorrect length of QT interval and vascular arrhythmias frequently appear in AN patients. One can also observe low voltage P-waves, QRS complexes and pathological dextrogyration, U-wave and atrial extrasystoles. Prolongation of QT interval is considered to be the marker of arrhythmia in AN paients. Resting heart rate is lower in AN patients, when compared with the control group, in which the measurement of balance indicators between the tension of the sympathetic nervous system and the vagus nerve activity indicates the dominance of vagus nerve stimulation. Authors referred to the studies using power spectral analysis.
References
1. Hoeck H.W. Review of the epidemiological studies of eating disorders, Int. Rev. Psychiatry, 1993; 5(1): 61-74.
2. Rajewski A. Jadłowstręt psychiczny W: Pużyński S., Rybakowski J., Wciórka J. red., Psychiatria Tom 2 Psychiatria Kliniczna, Wrocław, Elsevier Urban & Partner 2012, s. 481-489.
3. Ziora K., Świder M., Mazur B., Oświęcimska J., Jachimowicz M., Matusik P., Małecka-Tendera E. Ocena surowiczych stężeń wybranych cytokin (IL-1alfa, IL-1beta, IL-2) u dziewcząt z jadłowstrętem psychicznym i otyłością prostą, Endokrynol. Pediatr. 2013; 12 (3): 17-30.
4. Korek E., Krauss H., Gibas-Dorna M., Kupsz J., Piątek M., Piątek J. Fasting and postprandial levels of ghrelin, leptin and insulin in lean, obese and anorexic subjects, Prz. Gastroenterol. 2013; 8 (6): 383-389
5. Ostrowska Z., Ziora K., Oświęcimska J., Świętochowska E., Marek B., Kajdaniuk D., Wołkowska-Pokrywa K., Kos-Kudła B. Metabolizm kostny, osteoprotegeryna i ligand receptora aktywatora czynnika jądrowego-kappaB a wybrane hormony tkanki tłuszczowej u dziewcząt z jadłowstrętem psychicznym, Endokrynol. Pol. 2014; 65 (1): 33-39
6. Niedźwiedzka B., Karowicz-Bilińska A.:Ocena wartości stężeń neuropeptydu Y, leptyny oraz receptora leptyny u nastolatek chorych na anoreksję, Ginekol. Pol. 2013; 84 (4): 268-276
7. Krysiak R., Okopień B. Niedobór androgenów u kobiet, Wiad. Lek. 2013; 66 (4) cz. 2: 369-378
8. Przewoźnik D. A. Selected issues concerning the neurobiology of anorexia nervosa Neuropsychiatr. Neuropsychol. 2013; 8 (3/4): 118-122
9. Faccinhi M., Sala L., Malfatto G., Bragato R., Redaelli G., Invitti C. Low-K+ dependent QT prolongation and risk for ventriculararrhytmia in anorexianervosa. Int. J. Card., 2006; 106: 170-175
10. Kanbur N.O., Goldberg E., Pinhas L., Hamilton R.M., Clegg R., Katzman D.K. Second-Degree Atrioventricular Block (MobitzType I) in an Adolescent with AnorexiaNervosa: Intrinsicoq Aquired Conduction Abnormality. Int. J. Eat. Disord., 2009; 42: 575
11. Rechlin T., Weis M., Ott C., Bleichner F., Joraschky P. Alterations of Autonomic Cardiac Control in Anorexia Nervosa. Biol. Psychiatry, 1998; 43: 361-362
12. Nussinovitch M., Gur E., Kaminer K., Volovitz B., Nussinovitch N., Nussinovitch U. QT variability among weight-restored patients with anorexia nervosa. Gen. Hosp. Psychiatry, 2012; 34: 62-63
13. Vázquez M.,Olivares J.L., Fleta J., Lacambra I., González M. Cardiac Disorders in Young Women With Anorexia Nervosa Rev. Esp. Cardiol., 2003; 56(7): 669-673
14. Nahshoni E., Yaroslavsky A., Varticovschi P., Weizman A., Stein D. Alterations in QT dispersion in the surface electrocardiogram of female adolescent inpatients diagnosed with bulimia nervosa. Compr. Psychiatry, 2010; 51: 406-409
15. Takimoto Y., Yoshiuchi K., Kumano H., Yamanaka G., Sasaki T., Suematsu H.. QT interval and QT dispersion in eating disorders. Psychoter. Psychosom. 2004; 73: 324-328
16. Nahshoni E., Weizman A., Yaroslavsky A., Toledano A., Sulkes J., Stein D. Alterations on QT dispersion in the surface electrocardiogram of female adolescents diagnosed with restricting-type anorexia nervosa, J. Psychosom. Res., 2007; 62: 469-472
17. Kreipe R.E., Goldstein B., De King D.E., Tripton R., Kempski M.H. Heart rate power spectrum analysis of autonomic dysfunction in adolescents with anorexia nervosa. Int. J. Eating Disord,. 1994; 16: 159 –165
18. Kollai M, Bonyhay I, Jokkel G, Szonyi L. Cardiac vagal hyperactivity in adolescent anorexia nervosa. Eur. Heart J,. 1994; 15: 1113–1138
19. Roche F., Barthélémy J.C., Mayaud N., Pichot V., Divernoy D., Germain N., Lang F., Estoor B. Refeeding normalizes the QT rate dependence of female anorexic patients. Am. J. Cardiol,. 2005; 95: 277–280
20. Krantz M.J., Donahoo W. T., Melanson E.L., Mehler P.S. QT Interval Dispersion and Resting Metabolic Rate in Chronic Anorexia Nervosa. Int. J. Eat. Disord., 2005; 37(2): 167-168
21. Melanson E.L., Donahoo W.T., Krantz M.J., Poirier P., Mehler P.S..(2004). Resting and Ambulatory Heart Rate Variability in Chronic Anorexia Nervosa, Am. J. Cardiol. 2004; 94: 1219.
22. Klein-Weigel P., Rein P., Kronenberg F., et al. Microcirculatory assessment of vascular acrosyndrome in anorexia nervosa and analysis of manifestation factors. J. Psychosom. Res., 2004; 56: 145–148.
23. Krantz M.J., Mehler P.S. Resting tachycardia, a warning sign in anorexia nervosa: case report. BMC Cardiovasc. Disord., 2004; 4:10
24. Ohwada R., Hotta M., Kimura H., et. al. Ampulla cardiomyopathy after hypoglycemia in three young female patients with anorexia nervosa. Intern. Med., 2005; 44: 228–233
25. Sundararaghavan S, Pitts TY, Suarez WA, Johnstone C. Chest pain among adolescents with anorexia nervosa. Pediatr. Emerg. Care., 2005; 2: 603–605
26. M.G. Gentile, P. Pastorelli, R. Ciceri, G.M. Manna, S. Collimedaglia. Specialized refeeding treatment for anorexia nervosa patients suffering from extreme undernutrition. Clin. Nutr., 2010; 29: 627-631
27. A.K. Garber, N. Michihata, K. Hental, M.A. Shafer, A.B. Moscicki. A Prospective Examination of Weight Gain in Hospitalized Adoles-cents With Anorexia Nervosa on a Recommended Refeeding Protocol. J. Adolesc. Health, 2012; 50: 24-25
28. Tylec A., Olajossy M., Dubas-Ślemp H., Spychalska K. The possibility or coercion treatment? Anorexia nervosa - legal regulations. A case report. Psychiatr. Pol. 2013; 47(3): 531-539.
