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Anorexia nervosa (AN) can have a major impact on heart health.
The body’s largest muscle, the heart beats both day and night, pushing blood, nutrients, and oxygen to all tissues in your body. But the malnutrition often tied to anorexia can cause the muscle to grow smaller and weaker, inhibiting its ability to do this vital work.
Still, heart failure is one of the most treatable forms of heart disease, and it is possible to regain a healthy heart in time.
Signs of Heart Failure Caused by Anorexia
Heart failure may conjure the image of a heart that has stopped working entirely. But the malady actually describes a heart that isn’t pumping as well as it should be.
Every cell in your body relies on your heart. With each beat, the muscle pushes oxygen and nutrients in, nourishing cells and allowing them to work properly.
But a weakened heart doesn’t push as effectively. As a result, your cells begin to starve. The signs can be subtle, but they can feel like: 
- Shortness of breath
Even if these effects set in, you may not notice any issues with your heart. The symptoms can more often feel like trouble with everyday activities, like climbing stairs or carrying groceries.
A doctor can help you determine if you’re experiencing signs of heart failure.
How Does Anorexia Cause Heart Failure?
There are many aspects of anorexia nervosa that can contribute to heart failure. Some of the most common potential connections include: 
- Poor nutrition: A diet low in protein, thiamine, or both could harm your heart. Each beat can cause tiny tears, and without enough nutrients, your body can’t repair the damage.
- Poisoning: Some people with AN use powerful laxatives to aid weight loss. Some products, like ipecac, can damage heart muscle.
- Stress: Some forms of heart disease, such as Takotsubo cardiomyopathy, can be triggered by emotional or physical stress, including some of the stressors associated with anorexia nervosa.
- Refeeding syndrome: Anorexia nervosa often causes significant electrolyte imbalances. If you start eating too much again, too quickly, it can further the imbalance and trigger so-called refeeding syndrome. Heart failure can develop as a result.
Most of these issues develop over time. A restricted diet doesn’t immediately lead to heart failure, in most cases. But the longer unhelpful eating patterns go on, the more damage can be done to the heart.
Other Heart Problems Caused by Anorexia
While heart failure presents a significant problem for people who struggle with anorexia, it’s not the only heart issue connected to the condition. Many people with AN also develop heart rhythm abnormalities.
Your heart uses a complicated electrical system to trigger beats. Poor nutrition, including an imbalance of electrolytes, can throw off this delicate process.
Up to 40% of patients struggling with anorexia nervosa in one study were found to have long QT syndrome. A heart signaling disorder, the condition can cause fast and erratic heartbeats, leading to seizures, fainting, or sudden death. 
Anorexia has also been tied to an abnormally slow heartbeat. Called bradycardia, the condition is caused by a deteriorating heart muscle, leaving the organ too weak to properly pump blood through the body.
How is Heart Failure Treated?
Heart failure can be dangerous or even deadly, but happily, the condition is also treatable.
Working with a doctor to safely regain weight has been shown to significantly improve heart failure symptoms. One study found that a majority of patients had shown vast improvements in heart structure and even the reversal of heart damage after a period of weight recovery. 
In the most severe scenarios, circulation-assisting devices can be used to revive patients who suffer from heart attacks. These devices send an electrical shock to your heart, which can restart the muscle if it stops pumping. Follow-up treatments in these cases may include a pacemaker to keep your heart beating on time.
Maintaining Healthy Weight
Regardless of the treatment you receive, maintaining a healthy weight is an important aspect of keeping up heart health. Studies have shown that patients who revert back to a lower weight after a period of recovery may see a resurgence of related heart issues. 
As you continue along your recovery journey, it’s important to continue consulting with your doctor or medical team, to continue tracking your progress toward healing.
Anorexia and Heart Failure FAQs
If you or a loved one have showcased any signs of anorexia nervosa, or heart failure, you may have a number of questions.
Can anorexia cause heart problems?
Yes. Anorexia is closely related to several heart problems.
Limited food intake can reduce the size and strength of every muscle in your body, including your heart. And electrolyte imbalances caused by malnutrition can also harm the electrical system your heart relies on.
Can anorexia cause heart failure?
Yes, although it’s not the most common cardiac problem tied to anorexia.
The malnutrition that often accompanies anorexia can deprive your body of nutrients needed to repair damage to heart muscles. And products like laxatives, which are sometimes used by people who struggle with anorexia nervosa, can further harm your heart.
Are anorexia and heart attack connected?
Yes. The malnutrition often connected to anorexia can directly stop your heart from beating, or weaken the muscle to the point where it struggles to pump enough blood to the body. Either of these situations can be considered a heart attack.
Is anorexia heart damage permanent?
The type of damage caused by heart failure has been shown to improve in cases where patients regain—and then, maintain—a healthy weight. Still, this process can be delicate. It’s important to work with your doctor to regain and maintain weight in a safe and healthy way.
Recovery from Anorexia-Related Heart Damage
Your heart is arguably the most important muscle in your body, and may be put at risk by the unhelpful behaviors related to anorexia nervosa.
If you or a loved one have experienced any signs or symptoms of AN, you should speak with a doctor. Seeking help as soon as possible is important for limiting the potential heart damage that can be done by the condition.
But it’s important to remember that recovery is always possible, even after some heart damage has appeared. When it comes to seeking treatment for anorexia nervosa, it’s never too late.
- What Is Heart Failure? (2017). American Heart Association. Accessed August 2022.
- Sardar, M. R., Greway, A., DeAngelis, M., Tysko, E. O., Lehmann, S., Wohlstetter, M., & Patel, R. (2015). Cardiovascular Impact of Eating Disorders in Adults: A Single Center Experience and Literature Review. Heart views, 16(3) 88–92.
- Mont, L., Castro, J. (2003). Anorexia Nervosa: A Disease with Potentially Lethal Repercussions on the Heart. Revista Espanola de Cardiologica, 56(7) 652-653.
- Flamarique, I., Vidal, B., Plana, M.T., Andrés-Perpiñá, S., Gárriz, M., Sánchez, P., Pajuelo, C., Mont L., Castro-Fornieles, J. (2022). Long-Term Cardiac Assessment in a Sample of Adolescent-Onset Anorexia Nervosa. Journal of Eating Disorders, 10(12).
- What Is Heart Failure? (2022, May 24). National Heart, Lung, and Blood Institute. Accessed August 2022.
The opinions and views of our guest contributors are shared to provide a broad perspective on eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer a discussion of various issues by different concerned individuals.
We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.
Published January 31, 2023, on EatingDisorderHope.com
Reviewed & Approved by Jacquelyn Ekern MS, LPC