Zaburzenia kardiologiczne u 13-letniej pacjentki z jadłowstrętem psychicznym

Beata Kucińska, Ewa Smereczyńska, *Bożena Werner

Summary
Anorexia nervosa (AN) is an eating disorder characterized by an abnormally low body weight, intense fear of gaining weight and a distorted perception of body weight. This psychiatric disorder involves numerous systemic complications. Cardiac abnormalities are inherent with AN and they become more life-threatening as the anorexia nervosa becomes more severe. Anorexia nervosa has the highest mortality rate of all psychiatric disorders and the cardiac abnormalities are the leading cause of death because in AN structural, functional and rhythm-type changes can occur.
The authors present the case of a 13-year-old girl with AN admitted to the hospital in serious general condition. Her major complaints were: fatigue and vertigo. Upon physical examination her nutritional status was estimated as severe malnutrition with BMI of 12.2 kg/m². She was dehydrated, presented with bradycardia, muffled heart sounds and low blood pressure. Electrocardiography showed sinus rhythm with bradycardia and repolarization disturbances. Transthoracic echocardiography revealed pathological amount of fluid in pericardial sac, reduced left ventricular mass and systolic function, with decreased ejection fraction (EF – 49%) and shortening fraction (SF – 24%), as well as reduced systolic function of right ventricle with decreased fractional area change (FAC – 24%). She also presented the structural changes of atrio-ventricular valves: mitral valve prolapse (MVP), as well as slightly prolapsing leaflets of tricuspid valve with regurgitations. Improvement in cardiac function was observed with weight restoration. The authors highlight the importance of echocardiography check-up in patients with anorexia nervosa.

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