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February 27, 2020

Cardiac Complications of Eating Disorders

Cardiac Complications of Eating Disorders

By Dr. Mary Bretzman, physician at The Emily Program

“Why an EKG?”

“Why do you check my blood pressure lying down AND standing up?”

“Why am I dizzy when I stand?”

We often hear these questions from our clients with eating disorders. The answer? Because eating disorders can affect every part of the body, including the heart. Cardiac complications may occur as a result of the malnutrition, dehydration, and electrolyte imbalances commonly associated with these disorders.


Our bodies need fuel to function, and that fuel comes in the form of food broken into glucose and circulated throughout the bloodstream. Every cell relies on this supply of glucose. If we limit the supply by not eating enough, as is often the case in clients with restrictive eating disorders like anorexia, our bodies notice. There is less energy to use. The body is exquisitely good at recognizing this deficit and shifting into a conservation mode.

The “engine” of the cardiac system and the body itself, the heart, responds. The heart controls the blood pressure and the perfusion of blood to all parts of the body. When it needs to conserve energy, it decreases blood flow to “less necessary” parts of the body—the extremities. This can result in feeling cold, blue fingers, or a mottled, cobweb appearance to the skin.

If the starvation persists long enough, the heart itself can slow down. Clients may experience bradycardia, or a slow heart rate that drops to dangerously low beats per minute. In turn, a bradycardic heart rate affects blood pressure. Blood pressure levels can drop very low, often resulting in dizziness upon standing, walking, or exerting any energy. Fainting can occur.

EKG abnormalities show not only the rate of heart beats, but also how the electrical signals are guided through the heart. These electrical changes can become so pronounced that an irregular heart rhythm, or arrhythmia, can occur. This can result in death.

Doctors commonly refer to these cardiac complications as orthostatic or “starvation” heart rate changes. It is important to note that they can persist for a long time, even after starting to restore weight and nutrition.


In addition to contributing to malnutrition, eating disorders affect the hydration part of our bloodstream. Just as our bodies are reliant on normal glucose levels, they also depend on adequate hydration levels. Hydration is necessary to move blood throughout the body.

Restriction of fluids, frequent vomiting, misuse of laxatives and diuretics, and exercise without hydration can result in severe dehydration. These symptoms are considered “purging” or compensatory behaviors in eating disorders like bulimia.

Dehydration decreases the blood pressure and ultimately harms every organ of our body. The heart and kidneys are particularly sensitive to low fluid intake. If a person is unable to normalize the intake of fluids by consuming liquids, IV fluids may be considered as treatment.

Electrolyte changes

Our cardiac system is also very sensitive to the blood levels of key electrolytes: salt, potassium, glucose, and phosphorus. Cardiac cells react irritably to changes in these electrolytes and can cause abnormal heart rhythms, which can become very serious and potentially life-threatening.

The heart is the center of the body. It is the engine that powers all of the smaller systems, and without it, the body cannot function properly. Because eating disorders can viciously attack the cardiac system, we encourage all clients to pursue recovery. These illnesses are abusive, but treatment is available and can be very effective.

If you are concerned that you, a loved one, or your patient may have an eating disorder, we encourage you to reach out to The Emily Program. Find help for yourself and others online or call 1-888-364-5977 for more information.

Get help. Find hope.