The Cardiovascular Complications of Eating Disorders

Eating disorders have the highest mortality rate of any mental illness and a big part of this lethality are the cardiac complications caused by eating disorder behaviors.

What is a Cardiac Complication of an Eating Disorder?

Eating disorders involve severe behaviors related to food and exercise that will undoubtedly wreak havoc on the body. The malnourishment caused by eating disorder behaviors impacts the ability of the body and brain to function optimally and bodily systems such as the organs suffer extreme damage. It is not uncommon for individuals with eating disorders to suffer cardiovascular complications, that is, issues with their heart health and functioning.

Eating Disorders and Heart Failure

Heart failure plays a large part of the mortality rate of eating disorders. Eating disorder behaviors place such strain on the heart that it cannot function optimally.

It is frightening to consider that many of the statistics mentioned below regarding cardiovascular complications and eating disorders are likely much higher. Many individuals that pass away from heart failure due to eating disorder behaviors are misdiagnosed as “sudden death” or the heart complications are noted without the understanding that they were caused by an eating disorder.

Anorexia & Heart Failure

The severe restrictive behaviors involved in anorexia nervosa take a big toll on cardiovascular functioning. The malnutrition that results from anorexia nervosa can impact the electrical activity of the heart, which conducts the heart’s muscle contraction. This dysregulation leads to an abnormal heartbeat which can be fatal [1]. Malnutrition also shrinks the muscle in the heart, causing it to beat slower and pump less blood per beat. As the heart needs to work harder, it becomes strained.

A 2020 study confirmed that, due to the complications above, anorexia nervosa behaviors will inevitably impact the heart, with the study finding that “all severely undernourished AN patients had subclinical myocardial impairments [2].”

These impairments can become deadly, leading to approximately one-third of anorexia nervosa deaths [3].

Can Bulimia Affect Your Heart?

Bulimia Nervosa involves binging episodes followed by efforts to get rid of the food ingested by purging via vomiting and/or laxative/diuretic use. These behaviors lead to severe dehydration and metabolic disturbances such as “low serum levels of potassium (hypokalemia), low levels of chloride, metabolic alkalosis (vomiting) and acidosis (laxatives) [4].” The low levels of potassium can lead to abnormal heartbeat, as described above.

Individuals may also use ipecac to purge. Ipecac contains emetine, which “causes irreversible damage to cardiac cells leading to cardiomyopathy with ventricular dysfunction, congestive heart failure, ventricular arrhythmias, and even sudden cardiac death [4].”

For individuals with bulimia nervosa, the metabolic imbalances, dehydration, and malnourishment all leave them susceptible to severe cardiovascular damage and heart failure.

Related Reading

• • Long Term Effects of Eating Disorders on Health
  • Musculoskeletal System and Eating Disorders 
  • What Eating Disorders Can Do to Your Brain
  • Respiration Concerns from Anorexia or Bulimia
  • Digestion Issues Due to Eating Disorders
  • Your Brain and Eating Disorders
  • Circulation Issues from Disordered Eating
  • How Disordered Eating Affects Your Endocrine System
  • How EDs Affect Your Hair, Nails and Skin
  • What Anorexia and Bulimia Do to the Reproductive System
  • Your Immune System and Disordered Eating

Can Binge Eating Cause a Heart Attack?

Binge Eating Disorder can be related to cardiovascular concerns for reasons that differ to anorexia and bulimia nervosa. Individuals that engage in binge eating are less likely to experience dehydration or malnourishment but still do struggle with health consequences due to their behaviors. For example, approximately two-thirds of those with BED are considered to be medically “overweight” and their heart can be impacted by this. Larger bodies require increased metabolic demand, increasing the cardiac workload required for the body to function optimally [5]. This can cause strain on the heart. Being medically overweight can also lead to alterations in chamber dilations of the heart such as in the disorder Left Ventricular Hypertrophy (LVH), wherein the walls of the left chamber of the heart thicken and, therefore, cannot pump efficiently.

Bradycardia & Eating Disorders

Bradycardia is the medical term for a heart rate that is too slow based on an individual’s age and physical condition [6]. The average consideration is that Bradycardia occurs when an individual’s heart rate is 60 or below. Bradycardia is seen in up to 95% of patients with anorexia nervosa [7]. Slowing down of the heart rate is one of the body’s first reactions to malnutrition as it is the parasympathetic nervous system attempting to conserve the limited energy it is receiving [7] [3]. Bradycardia is a symptom that will most certainly be found in individuals with eating disorders whose behaviors involve malnutrition and dehydration.

Can Eating Disorders Cause Low Blood Pressure?

Low blood pressure, also referred to as “hypotension,” is considered blood pressure that is less than 90/50 [7]. Hypotension can undoubtedly occur due to eating disorders, as it is caused by the heart muscle weakening. Malnutrition and dehydration can commonly cause the heart muscle to weaken. When individuals experience low blood pressure, their body does not have enough fluid volume to push blood throughout the whole body, leading to impaired functioning.

Can Your Heart Recover from Bulimia and Other Eating Disorders?

The body is incredibly resilient and studies have shown that “bradycardia, low blood pressure and most other complications associated with anorexia are reversible with medically-supervised nutritional rehabilitation and weight restoration [7].” One study conducted with adolescent women found that, despite all participants experiencing serious cardiac complications due to their eating disorder, weight restoration and refeeding reversed this damage [8].

This can lead to hope that despite the serious, life-threatening consequences that eating disorder behaviors can have on the heart, there can be healing in eating disorder recovery.

Resources

[1] Hamachi, M. et al. (2020). Echocardiographic abnormalities in 124 severely malnourished adult anorexia nervosa patients: frequency and relationship with body composition and biological features. Journal of Eating Disorders, 8:66.

[2] Sardar, M. R. et al. (2015). Cardiovascular impact of eating disorders in adults: a single center experience and literature review. Heart Views, 16:3.

[3] Goldberg, R. L. (2020). The Eating Disorder Trap. BookLogix, Alpharetta, GA.

[4] McCallum, K. (2015). Bulimia and cardiovascular risk: what does the research show? Eating Disorder Hope, Retrieved from https://www.eatingdisorderhope.com/bulimia-and-cardiovascular-risk-what-does-the-research-show.

[5] Poirier, P. et al. (2006). Obesity and cardiovascular disease: pathophysiology, evaluation, and effect of weight loss. Circulation, 113:6.

[6] Unknown (2016). Bradycardia: slow heart rate. American Heart Association. Retrieved from https://www.heart.org/en/health-topics/arrhythmia/about-arrhythmia/bradycardia–slow-heart-rate.

[7] Unknown (2020). Low heart rate (bradycardia) and anorexia. ACUTE Center for Eating Disorders and Severe Malnutrition. Retrieved from https://www.acute.org/resource/bradycardia-anorexia.

[8] Mont, L. et al. (2003). Reversibility of cardiac abnormalities in adolescents with anorexia nervosa after weight recovery. Child & Adolescent Psychiatry, 42:7.

Author: Margot Rittenhouse, MS, LPC, NCC

Page Last Updated & Reviewed By: Jacquelyn Ekern, MS, LPC on October 29, 2021