Severe Sinus Bradycardia in Anorexia Nervosa: A Case Report and Focused Review of Cardiovascular Complications

Anorexia nervosa (AN) is a severe psychiatric disorder characterized by restricted energy intake, intense fear of weight gain, and body image disturbances. It predominantly affects adolescent females, with rising prevalence, especially during the COVID-19 pandemic. AN leads to multiple medical complications, including cardiovascular issues such as bradycardia, which may result from malnutrition, electrolyte disturbances, and myocardial atrophy. We report a case of a 19-year-old female patient with a three-month history of weight loss, resulting in a weight of 38 kg and a body mass index of 14 kg/m², indicative of severe malnutrition. She presented with a fluctuating appetite, fatigue, muscle pain, mood changes, and sleep disturbances. Clinical evaluation revealed severe sinus bradycardia (30-40 bpm) and a small heart volume, with reduced stroke volume (<45 mL/beat) and cardiac output (<3.5 L/min). Electrolyte analysis showed mildly reduced magnesium, and inflammatory markers showcasing mild elevation of erythrocyte sedimentation rate. Additional psychiatric findings, including obsessive weight monitoring and self-induced vomiting, led to a diagnosis of AN. This report underscores the importance of recognizing bradycardia as a significant cardiovascular manifestation of AN. Early psychiatric intervention and multidisciplinary management are crucial to address malnutrition, electrolyte imbalances, and cardiac dysfunction to prevent further complications and improve patient outcomes.