What is Anorexia and How Does it Affect the Heart?

QUESTION: I am trying to fully understand the extent of an illness called
"anorexia". Can you tell me something about it and please describe any
actions it might have on the heart. Please consider this question for your
column as it is most important to me.
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ANSWER: Anorexia nervosa is a serious illness. Fifteen percent of all
anorexia sufferers die, which makes it one of the deadliest of all psychiatric
disorders. Sudden deaths among anorexics are often due to the serious damage
that anorexia causes to the heart.
Researchers have known for a long time that anorexics have abnormal heart
rhythms, including heart rates that are too fast or slow or lack the proper
rhythm. Their hearts are also shrunken in size. It had always been thought
that when the body is starved, the heart and the brain are spared at the
expense of other parts of the body, but an anorexic's heart appears to lose
more weight and size proportionately than the rest of the body. The size of
the left ventricle, one of the chambers of the heart, in anorexics is
especially reduced. Bulimia--eating and then vomiting--can also cause heart
problems due to chemical imbalances in the body.
Because of these heart changes, anorexics cannot exercise as long as
normal during exercise stress tests. Their heart rates and blood pressures do
not respond normally to the extra effort of exercise, as a healthy person's
would. It is still not known whether the heart returns to normal after a
treated anorexic returns to a normal weight or whether these abnormalities are
permanent. Some studies have shown that the heart does increase in size as
weight is gained.
As a part of the treatment for anorexia nervosa, anorexics must therefore
be followed carefully with frequent evaluations of their hearts.