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kartinimd1
ED clinician - FEAST Advisory Panel member
Registered: March 03, 2008
Posts: 48

    Nov 07, 2008 at 07:55 PMReply with quote#23
Maria,
You asked for a doctor to jump in (hope this helps):

There are two important issues to understand regarding “heart effects” in children and adolescents with an eating disorder: one is bradycardia (too low a heart rate) and the other is being orthostatic by either heart rate or blood pressure. These two things are defined a little differently by different institutions, but only a little. At the Kartini Clinic we define bradycardia of concern as a daytime heart rate of 50 beats per minute or less. A concerning degree of orthostasis would be a pulse change of 35 beats per minute or greater after lying for 5 minutes and then standing for 2.5 minutes; or a drop in blood pressure of 10 mmHg or greater from lying to standing.

In terms of “heart damage”, these parameters are more an indication of the severity of the underlying eating disorder than of the underlying cardiac damage. But we use them to hospitalize children in order to restore them medically. We don’t spend any time wondering whether or not there might be some healthy athletic child whose heart rate is actually 50—remember children are not adults, and these numbers are valid only in the setting of an eating disorder.

But what does “heart damage” have to do with it? I think of it this way: the heart is a muscle, not unlike the ones in your child’s arms. When you see the wasting of their skeletal muscles understand that that is what you would you see if you were able to get a look at your child’s heart: wasted musculature. So the heart muscle has been weakened by starvation which affects its ability to “pump uphill” (as when we are standing and it has to move blood from the chest to the brain). Because it cannot beat “stronger”, it tries to make up the same about of blood by beating “faster”—hence the rise in heart rate. When even this can’t make up the difference, the blood pressure drops. We wait 2 and 1/2 minutes to take the second reading because we are not interested in that first flash of dizziness or faintness that anyone can get when they first stand up. Re-feeding and weight restoration seems to reverse these effects on the heart. So while orthostasis may or may not represent heart damage, it does represent heart compromise.

With bingeing and purging we are merely adding other stressors (electrolyte imbalances) to the already weakened heart.

We suggest that doctors everywhere who see eating disordered patients take vitals in the same way so that we can all compare “apple to apples”.

Often many different mechanisms will lead to a similar or the same symptom, such as “fever” or “orthostasis”.
   
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