Friars Dara, Walsh Orla, McNicholas Fiona
Department of Psychiatry, School of Medicine, University College Dublin, Dublin, Ireland.
, Mount Pleasant, Australia.
J Eat Disord. 2023 Jan 30;11(1):13. doi: 10.1186/s40337-022-00724-5.
Eating disorders (EDs) are serious conditions predominantly affecting adolescents and young adults (AYAs) and pose a considerable threat to their health and wellbeing. Much of this increased morbidity and mortality is linked to medical compromise, especially cardiovascular abnormalities. Rates of presentation to both community and inpatient medical settings have increased in all age groups following the Covid-19 pandemic and subsequent "lockdowns", with patients presentations being more medically compromised compared to previous years. This has implications for clinicians with regard to the performance of competent cardiovascular assessments and management of findings.
This paper is a practical resource for clinicians working with AYAs in whom EDs may present. It will provide a brief summary of the physiological context in which cardiovascular complications develop, systematically outline these complications and suggest a pragmatic approach to their clinical evaluation.
Relevant literature, guidelines and academic texts were critically reviewed. Conclusions were extracted and verified by a Child and Adolescent Psychiatrist and Adolescent Paediatrician, with suitable expertise in this clinical cohort.
The cardiovascular complications in EDs are primarily linked to malnutrition, and patients presenting with Anorexia Nervosa are most often at greatest risk of structural and functional cardiac abnormalities, including aberrations of heart rate and rhythm, haemodynamic changes and peripheral vascular abnormalities. Other cardiovascular abnormalities are secondary to electrolyte imbalances, as seen in patients with Bulimia Nervosa. More recently defined EDs including Avoidant/Restrictive Food Intake Disorder and Binge Eating Disorder are also likely associated with distinct cardiovascular complications though further research is required to clarify their nature and severity. Most cardiovascular abnormalities are fully reversible with nutritional restoration, and normalisation of eating behaviours, including the cessation of purging, though rare cases are linked to cardiac deaths. A detailed clinical enquiry accompanied by a thorough physical examination is imperative to ensure the medical safety of AYAs with EDs, and should be supported by an electrocardiogram and laboratory investigations. Consideration of cardiovascular issues, along with effective collaboration with acute medical teams allows community clinicians identify those at highest risk and minimise adverse outcomes in this cohort.
饮食失调（EDs）是主要影响青少年和青年成年人（AYAs）的严重疾病，对他们的健康和幸福构成相当大的威胁。这种发病率和死亡率的增加很大程度上与医疗状况不佳有关，尤其是心血管异常。在新冠疫情及其后的“封锁”之后，所有年龄组在社区和住院医疗环境中的就诊率都有所上升，与前几年相比，患者的医疗状况更差。这对临床医生进行有效的心血管评估和对检查结果的管理具有重要意义。
本文是为可能患有饮食失调症的青少年和青年成年人患者提供临床服务的临床医生的实用资源。它将简要概述心血管并发症发生的生理背景，系统地概述这些并发症，并提出对其进行临床评估的实用方法。
对相关文献、指南和学术文本进行了严格审查。结论由一名儿童和青少年精神科医生以及一名青少年儿科医生提取并核实，他们在这一临床队列方面具有适当的专业知识。
饮食失调症中的心血管并发症主要与营养不良有关，患有神经性厌食症的患者最常面临结构和功能性心脏异常的最大风险，包括心率和心律异常、血流动力学变化和外周血管异常。其他心血管异常继发于电解质失衡，如在神经性贪食症患者中所见。最近定义的饮食失调症，包括回避/限制性食物摄入障碍和暴饮暴食症，也可能与独特的心血管并发症有关，不过需要进一步研究来阐明其性质和严重程度。大多数心血管异常通过营养恢复和饮食行为正常化（包括停止催吐）是完全可逆的，尽管罕见病例与心脏死亡有关。详细的临床询问并辅以全面的体格检查对于确保患有饮食失调症的青少年和青年成年人的医疗安全至关重要，并且应由心电图和实验室检查提供支持。考虑心血管问题，并与急性医疗团队进行有效协作，可使社区临床医生识别出该队列中风险最高的患者，并将不良后果降至最低。
