Sudden death in eating disorders

Figures & data

Table 1 Sudden death related to cardiovascular complications: main findings

At least one-third of all deaths in patients with anorexia nervosa are estimated to be due to cardiac causes, mainly sudden death^Citation14,Citation15,Citation18 Cardiovascular complications are common and they have been reported in up to 80% of patients with anorexia nervosa, mainly in the form of bradycardia, hypotension, arrhythmias, repolarization abnormalities, and sudden death by up to 10% of the cases with these types of cardiovascular disturbances^Citation14^–^Citation16,Citation19^–^Citation21 Food restriction can lead to increased vagal tone, bradycardia, orthostatic hypotension, syncope, arrhythmias, congestive heart failure, and sudden death^Citation22 Duration of the QT interval of the electrocardiogram is a function of the heart rate and a prolonged QT interval is a biomarker for ventricular tachyarrhythmia and a risk factor for sudden death^Citation15,Citation16,Citation79 The measurement of QT interval has a poor predictive value for the recognition of patients who are at particular risk of sudden death. A measured QT interval of >600 milliseconds is associated with a significant risk of sudden death, but few patients usually have such long QT intervals^Citation24 In refeeding syndrome, congestive heart failure results from decreased ventricular mass and myofibrillar atrophy, causing decreased stroke volume and reduced capacity of the cardiovascular system^Citation4 Some cases of myocardial infarction have been described in eating disorder patients. This complication increases the risk of sudden death among those patients^Citation35,Citation36 Another mechanism of cardiovascular mortality and sudden death among eating disorder patients is the alteration in sympathovagal balance^Citation39

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