Saturday 24 August 2013

Why didn't the cardiac consultant make the connection between a slow heart and anorexia?

Yesterday, while we were being interviewed for BBC's "Inside Out" programme, it struck me again: why the hell didn't the heart consultant at the Leeds General Infirmary make the connection between a slow pulse rate and anorexia when our son was rushed into his cardiac ward in January 2010 (see my book "Please eat...")? Especially as today I came across this excellent article which describes the connection in no uncertain terms. Surely, as a heart consultant at a leading hospital, he should have made the connection?

Instead, he was more interested in the fact that Ben was sporty. He told us that athletes' hearts can slow right down so, in the absence of any other reason for Ben's pulse dropping to 29 beats per minute, that was probably the cause.

"BUT BEN HAS ANOREXIA!" I said, several times.

But the penny didn't drop - neither with the consultant nor the other medical staff on the ward who were monitoring Ben and trying to work out why his pulse was so dangerously low.

Indeed, they seemed to know very little about eating disorders, which is really odd seeing as how Bradycardia (very low pulse rate) is so common with the illness. And that heart failure is one of the biggest killers of people with an eating disorder.

The more I think about it, the more puzzling (and frightening and shocking) it is that none of the staff I spoke to on the cardiac ward at Leeds General Infirmary made the connection.

The article I refer to above (from the Cleveland Center for Eating Disorders) says:

In general, as one loses weight one loses muscle mass. With the loss of muscle mass there may be loss of heart mass as the heart is a muscle. ... To conserve heart muscle and thus keep the entire body functioning as well as possible there will be a slowing of heart rate, called bradycardia. Bradycardia can be very dangerous and is one of the leading causes of illness, hospitalization, and death for those with eating disorders. Heart rates in the 40s or lower are particularly dangerous. ...

Sometimes there is confusion about the relationship of heart rate and exercise. Many patients erroneously believe, and are told, that a low heart rate is evidence of being an athlete. There are no studies showing that significant and rapid weight loss is normal for an athlete or healthy for the heart. The confusion usually results from the fact that, in general, athletes with low heart rates have low heart rates because they have gained significant muscle mass, including mass in their heart, and their heart does not have to beat as often to provide adequate oxygen and blood for the body. This is most definitely not the case in situations of weight loss, starvation and smaller than normal hearts. One should never assume that in the presence of an eating disorder that a low heart rate has anything to do whatsoever with athletic ability. A low heart rate is almost always due to the illness itself. ...

Take note, Leeds General Infirmary!

1 comment:

  1. Probably the same Consultant I saw.... He too seemed unconcerned by my weird ECG - because I was not overweight, didn't have high cholesterol or high blood pressure. Actually, my blood pressure was "nice and low".

    I subsequently had a heart attack - albeit a small one, but one that has caused permanent changes to my cardiac muscle which increase my risk of sudden death and/or heart failure in the future.