2009 Southern Regional Meeting Abstracts

Purpose of Study: Anorexia nervosa (AN) is associated with extreme bradycardia and echocardiographic findings including left ventricular hypertrophy (LVH), mitral valve prolapse, infectious endocarditis, pericardial effusion (PCE) and poor function. Extreme athletes (EA) develop "athletic heart", which consists of LV dilation and hypertrophy. AN patients who exercise to the extreme, are subject to the combined stressors of each state, and may develop findings of each. We describe 3 girls with AN and EA, with associated cardiac findings which subsequently reversed with weight gain and rest.
Methods Used: This is a retrospective chart review. All patients were followed in an outpatient setting, re-fed slowly, and were asked to refrain from extreme exercise. Serial EKGs and echocardiograms were obtained as patients regained weight.
Summary of Results: See Table 1. All 3 patients exercised to the extreme, and lost 1/3 of their initial body weight. They all manifested bradycardia and diminished global LV systolic function with the weight loss and exercise. Two out of three had LV dilation, but none had LVH. With ~ 5 kg weight gain, all had return of normal LV systolic function. One persisted with increased LV dimension even when function returned to normal; this patient also manifested ectopy.
Conclusions: Extremes in body mass indices have a myriad of effects on the cardiovascular system, which appear to resolve as patients’ BMI move toward normative. Additionally, EA is associated with increased LVED and LVH. These girls did not manifest LVH, and may not have been able to mount a normal response. Patients with extremes in weight should be followed prospectively with sensitive echocardiographic parameters to supplement counseling regarding further weight gain and loss. The molecular cascades and neurohormones involved in these diseases should be studied.

Table 1. Degree of Weight Loss, Exercise and Cardiac Findings

Patient # and Age	BMI	Wt Loss	Physical Activity (all 120 min/day)	Resting EKG	Echo EF (Normal >55%)	LV end-diastolic dimension	Result with ~ 5 kg weight gain
1, 17 y	15.6	22 k	basketball	Sinus rate 35	50%	Increased	Nl function, nl dimension
2, 17 y	16.6	19 k	volleyball	Sinus rate 55	44%	Normal	Nl function, nl dimension
3, 21 y	16	19 k	running	Ventricular Bigeminy rate 62	46%	Increased + PCE	Nl function, increased dimension