Content area
Full Text
Key Words: Anorexia nervosa; Heart; Myocardium; Autopsy
ABSTRACT
Objectives: Anorexia nervosa (AN) is an eating disorder with high mortality and morbidity. Much of the mortality is related to cardiovascular complications manifesting with electrocardiogram abnormalities and morphologic abnormalities documented on ultrasound. However, gross and histologic abnormalities in the heart have been rarely described in association with this eating disorder.
Methods: We present an autopsy case of an adult patient with AN. We describe the clinical presentation of this patient, as well as significant gross and histologic abnormalities of the heart, and discuss their implications.
Results: At autopsy, the heart was small with mainly a small left ventricle. Histologically, we found endocardial and interstitial fibrosis, areas of myxoid material deposition with mast cells in the background, and increased cytoplasmic lipofuscin.
Conclusions: The gross findings in the heart correlate with the previously described anomalies on cardiac ultrasound of patients with AN. The fibrosis and myxoid material deposition might be a direct consequence of starvation and the mechanism of death in some patients with AN.
Anorexia nervosa (AN) is a psychiatric disorder in which individuals restrict energy intake, leading to severe low weight (defined as a body mass index [BMI] of <18.5 kg/m2). This is accompanied by an intense fear of gaining weight and a distorted perception of body weight and shape.1 A meta-review conducted to explore the risks of all-cause and suicide mortality in major mental disorders found that substance abuse disorders and AN had the highest mortality risks. AN had a standardized mortality ratio of 5.9.2
Registered incidence rates of AN are up to eight per 100,000 persons. The mean prevalence rate of AN for young females is 0.3%.3 However, the elimination of amenorrhea as a stringent criterion for AN in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders may increase the incidence of AN in women.4
AN is associated with many medical complications.5,6 However, the most concerning are those related to the cardiovascular system. Heart-related complications such as arrhythmia related to a possible prolonged QTc interval and/or electrolyte disorders, hypotension, cardiac structural abnormalities, and bradycardia all lead to increased ity.7 The complications of AN are a direct result of weight loss and malnutrition. Starvation induces protein and fat catabolism, which...