Anorexia Nervosa

Exercise Electrocardiography Extinguishes Persistent Junctional Rhythm in a Patient with Severe Anorexia Nervosa

By Philip S. Mehler, MD, FACP, FAED, CEDS


Among psychiatric conditions, anorexia nervosa carries the highest mortality, in part due to the propensity for rhythm disturbances among patients with advanced disease. Patients with anorexia nervosa are prone to both bradycardia and tachyarrhythmias, though mortality has not been associated with the former. To date, only one case of junctional rhythm in the setting of anorexia nervosa has been previously described, which was unremitting and required prolonged hospitalization. We report a case of persistent accelerated junctional rhythm where a formal exercise electrocardiography study demonstrated rapid reversion to sinus rhythm with graded exercise. Despite a 22-day hospitalization the patient never reverted permanently to sinus rhythm. This underscores the heightened vagal tone that may be seen among patients with severe anorexia nervosa. Despite this, it may be rapidly extinguished with sympathetic overdrive during exercise. In this context, exercise electrocardiography appears to be a safe, noninvasive means of assessing cardiac conduction and chronotropic reserve in this population.

Written by

Philip S. Mehler, MD, FACP, FAED, CEDS

Dr. Philip S. Mehler began his career at Denver Health more than 35 years ago and was formerly its Chief of Internal Medicine and then Denver Health’s Chief Medical Officer (CMO) until he was promoted…

ACUTE Earns Prestigious Center of Excellence Designation from Anthem
In 2018, the ACUTE Center for Eating Disorders & Severe Malnutrition at Denver Health was honored by Anthem Health as a Center of Excellence for Medical Treatment of Severe and Extreme Eating Disorders. ACUTE is the first medical unit ever to achieve this designation in the field of eating disorders. It comes after a rigorous review process.

Center of Excellence Logo