Cardiovascular Consequences of Anorexia Nervosa: QT Prolongation, Bradycardia, and Structural Cardiac Changes

Anorexia nervosa (AN) is a severe psychiatric disorder with profound cardiovascular consequences, including QT interval prolongation and bradycardia. These abnormalities contribute to an increased risk of life-threatening arrhythmias, sudden cardiac death, and long-term cardiac dysfunction. Although electrolyte imbalances and malnutrition are also recognized as key contributors, the precise mechanisms underlying these disturbances remain unclear. We conducted a comprehensive literature review using PubMed, Scopus, and Google Scholar to identify relevant studies published in the last 2 decades. Articles focusing on the cardiovascular impact of AN, particularly those addressing QT prolongation, bradycardia, structural cardiac changes, and autonomic dysfunction, were included. Corrected QT interval prolongation in AN varies widely across studies, with reported prevalence rates ranging from 0% to 40%, largely dependent on the applied threshold and patient population. Although some studies suggest that QT prolongation is not an inherent feature of AN, extrinsic factors such as hypokalemia, psychiatric medications, and refeeding complications significantly increase risk. Bradycardia in AN is driven primarily by autonomic dysfunction, metabolic adaptations, and reduced myocardial mass, with severe cases predisposing patients to syncope, hypotension, and cardiac arrest. Given the significant morbidity and mortality of these complications, a multidisciplinary approach is essential for timely diagnosis, prevention, and treatment. Further research is warranted to elucidate the underlying pathophysiological mechanisms and optimize therapeutic strategies for AN-related cardiac dysfunction.