Abstract 14733: Fluid Around a Small Heart- Cardiac Manifestation of Anorexia Nervosa

Abstract

Background: Anorexia Nervosa (AN) is an eating disorder which is characterized by an abnormally low body weight (BMI<18.5), a distorted perception of weight and an intense fear of gaining weight. It is prevalent in about 0.3 to 1% of the US population. Diverse cardiovascular complications are noted in these patients including decreased cardiac output, left ventricular mass and dimensions; pericardial effusion, bradycardia, hypotension and prolonged QT interval. We report a patient presenting with recurrent chest pain, and was diagnosed to have pericardial effusion secondary to AN. Case Presentation: A 27-year-old female with history of iron deficiency anemia, benign ethnic neutropenia, anorexia nervosa and borderline personality disorder, presented with insidious onset of atypical chest pain in the substernal region. Her BMI at presentation was 18.4, vital signs and systemic examination were normal. EKG showed a prolonged QT interval. She was noted to have normal blood cell counts, metabolic parameters and cardiac enzymes. A limited bedside echocardiography was normal except for the presence of mild pericardial effusion. She was treated with anti-inflammatory agents and discharged. A week later she presented with similar complaints. Management: Repeat cell counts were normal. Electrolytes revealed mild hypokalemia. Her CXR showed evidence of microcardia with a pulmonary artery diameter of 0.40. A repeat echocardiogram showed persistence of mild to moderate pericardial effusion. Etiological evaluation was negative for infections, autoimmune markers, and thyroid abnormalities. There was no evidence of ischemia and no rhythm abnormality. Her symptoms improved with analgesics and reassurance. Conclusion: Eating disorders like AN, have protean cardiovascular manifestations. Atypical chest pain in patients with AN is mostly idiopathic (38%) in the absence of risk factors. Silent pericardial effusion is found in about 22% to 71% of patients with AN. In these patients, factors like low BMI, rapid weight loss, low T3 levels, and IGF-1 levels correlate with pericardial effusion. Most patients show resolution of the effusion, normal cardiac dimensions and QT interval, after weight restoration without further intervention necessary.