Congestive heart failure as cause of death in an anorexia nervosa fatal case

Anorexia nervosa (AN) is a psychiatric disease predominantly affect- ing adolescent girls and young adult women characterized by severe eating disorders that lead to chronic protein–energy malnutrition and high lifetime mortality [1]. An excess mortality from cardiovascular dis- eases for AN patients has been reported [1]; patients with AN show a predisposition to sudden death with no apparent anatomical cause. Most of the cardiovascular associated mortality and morbidity in AN, is likely to stem from arrhythmia: QT prolongation [2], first degree- heart block, ectopic atrial foci, premature ventricular complexes, bradycardia, and other arrhythmias are seen. Other cardiac findings in AN include hypotension, mitral valve prolapse, and decreased cardiac mass [3]. Finally, heart failure has been reported [4]. We report a fatal case of AN in which we investigated the cardiac morphology to elucidate the heart involvement and the pathophysio- logic mechanism leading to death in this case.