Parenting & Caregiving > Heart problems

My friend is in recovery but she still struggles a lot with restriction. She is not underweight anymore but lately she has been restricting severely again and she gets chest pains and irregular heart beats. She doesn't want to go to the doctor because she is terrified and really anxious about it, but I'm afraid that she is in danger. She doesn't have this feeling in her chest all the time, it is mostly at night when she's in bed and whenever she does some type of physical activity. I'm not really sure how to help her and I guess I'm wondering what might be going on and if she is in immediate danger?

December 24, 2011 | Registered Commenteralmondbutter

Unfortunately, I've pretty much the same problem. I've been anorexic for 2 years. At first I was experiencing chest pain, palpitations and interpreted it as a sign of anxiety. Recently I was quite depressed and stressed (more than usually that is) and my heart started to act really funny - it literally hurts at different times of day. At first I thought it was due to weight loss that took place in the last 2-3 weeks (not intentional- I don't even know how it happened) and hoped that if I eat more I'll alleviate the pain and things will be fine (it's Christmas after all). It didn't. I still experience the pain and in addition I feel like my heart and lungs are too big for my chest or the other way round. I'm wondering how serious that is. Did I really damaged my heart or it's just a warning sign?

December 25, 2011 | Registered Commentersnowqueen

Hello there.

You are right, your friend is in danger.

She is experiencing something called tachycardia. It is a racing heart beat that often occurs when you are resting (that's why it is happening for her at night) and it signifies electrolyte imbalances that are happening due to starvation. We need an exact balance of electrolytes (sodium, potassium, magnesium, chloride, calcium and bicarbonate) because that is how we get a steady and strong heart beat. The electrolytes have to be in balance for the electrical signal to the heart to contract to be strong and steady.

Most people who don't starve can experience occasional tachycardia and it is harmless. However, for patients who starve it is an early warning sign that they may experience a heart attack with any kind of exertion or exercise. It is also a sign that their heart rate may become so irregular that they experience something called fibrillation that will require immediate emergency attention.

The chest pains are also of equal concern because it will likely suggest the heart muscle itself is damaged. During starvation the body has to find extra energy from somewhere so it pretty much literally eats its own muscles and bones. The heart is a muscle and so it is as prone to being "eaten" during starvation as any other muscle.

The risk to the heart is not limited to being clinically underweight. That she has begun restricting again (that's a relapse) likely as soon as she got to the bare minimum "healthy" weight (around BMI 18.5) then the heart has not fully healed through her first effort at recovery.

Ideally, you need to involve her family.If you and she are both under age 18, then you speak with your parents to have them speak to her parents about the situation. I know you will feel disloyal, but you are saving her life and in the end when she does recover fully she will thank you for it.

If you and she are adults, then you need to speak with her family or whichever loved ones have been involved and supportive of her efforts at recovery so far.

She is experiencing massive anxiety actually due to starvation. The brain is very sensitive to starvation and it does not run well at all on any energy deficits. A person who is severely restricting calories will become highly anxious about everything, paranoid, panicked and obsessive. Those behaviors are not due to her being "mentally ill" but rather due to the lack of energy going to the brain for it to function normally.

Because of this, it is unlikely that you can reason with her that she must see her doctor immediately. Whether she is over or under 18, it is best that her parents (or guardians or spouse) be the ones to get her in for some immediate medical attention.

I dont' want you to feel solely responsible for saving your friend. If you think you can speak with her directly and offer your help and support to get her to the doctor, then by all means do so. But don't beat yourself up in any way if she is unable to respond to your offer to help her get medical attention. But it is also not one of those times when you should be keeping your friend's secret. And if you are under age 18, then you need to involve your own parents because your friend's situation is not something you should be trying to manage on your own as well -- you need support too.

She is very lucky to have you as a friend and I suspect that she has let you in and told you of her anxiety precisely because the real part of her is looking for someone to get her help (her eating disorder naturally does not want the help at all). But it is time for you to pass the baton and find some people in her life who can get her medical help as soon as possible.

I hope this helps. Best wishes, Gwyneth.

December 25, 2011 | Registered CommenterGwyneth

Dear snowqueen:

As with my previous message to the OP, your circumstances need attention as well.

Are you in active recovery at the moment? By that I mean, are you eating at least 2500 calories a day (if you are over the age of 25) or 3000 calories a day (if you are under the age of 25) and remaining sedentary?

You have to eat a lot of food for a long time to recover. Restricting calories for a little as 6 months can result in hundreds of thousands of calories' worth of damage to the body.

It's great news that you intend to eat more through the Christmas season, but keep it going until your body naturally hits its optimal weight and stops gaining all on its own (you don't have to restrict calories to get the body to stop gaining weight -- it does that as soon as it hits the optimal weight for you).

If you are, then you will need to be patient because the repairs from starvation take many months. The good thing is that your heart will be completely repaired at the end of the recovery process.

Any issues with tachycardia (racing heart beat while at rest), chest pains, and/or bradycardia (a resting heart beat of 55 or under) should always be investigated and monitored by your doctor as you go through recovery.

If you are exercising at all, then stop immediately. Let your body use the energy to repair the damage and give it all the time it needs to do so.

If you are not in active recovery just yet, then that is even more reason to go see your doctor and have an ECG to get some sense of the status of your heart at the moment.

Also keep in mind, that restricting calories causes extreme anxiety (feeling tremendously stressed), depression, paranoia and compulsion -- in other words some of the moods you are experiencing are because the brain cannot function normally without enough energy coming in.

If you start re-feeding at 2500 to 3000 a day (depending on your age) you will find that sometimes the anxiety will actually increase for a little bit but then it will ease up considerably if you keep going. You will also find that your depression will improve with steady re-feeding as well.

No matter where you are in the process, a check in with your doctor is in order and stay sedentary until that time.

I hope this helps answer your concerns as well. Best wishes, Gwyneth.

December 25, 2011 | Registered CommenterGwyneth

Hi, thank you for your response.
I am 23 and my friend is 25. Her family lives in another country, she moved here temporarily for treatment, which is where I met her. I don't know her family and I don't really know how to contact them or if they can even do anything for her. She is basically on her own and she no longer is in contact with the treatment centre.
I tried to talk to her about how dangerous it was, but she told me that when she gets the irregular heart beats she takes an electrolyte drink or eats a small amount and it usually helps her feel better. I feel kind of helpless, I'm not really sure if there is anything I can do to help her except try to convince her to go back to treatment.
Do you think that taking an electrolyte drink will keep her safe in the mean time?

December 26, 2011 | Registered Commenteralmondbutter

I am sorry that the circumstances mean there is no one to intervene. You are right that all you can do is indicate she should see a physician immediately, but after that it is up to her.

An electrolyte drink will not keep her particularly safe if she continues to restrict calories over all. Electrolyte drinks replenish the stocks of all electrolytes for healthy individuals. They are best used during endurance sports. While electrolyte drinks are sometimes used as an adjunct to more intensive medical support for patients, they are not a good lone substitute for the medical intervention her friend really requires at this point.

In her case she may more likely require the replenishment of just one or two specific electrolytes, rather than all in equal proportion.

This is why during the re-feeding process blood electrolyte levels are closely monitored for severe anorexics because it matters which electrolyte may be out of balance as to the choice of specific electrolyte support that is decided upon.

What this means is that while she may alleviate the tachycardia temporarily, she may also be slowly increasing the imbalance she has overall, which will lead to other severe medical crises.

Also the tachycardia is not exclusively the result of electrolyte imbalances. Tachycardia also presents due to heart muscle damage (due to starvation) and that can only be healed with sufficient rest (no exercise or exertion) and more than enough energy intake on a daily basis for many months.

If she is no longer in contact with the treatment centre, then it is clear she is focused on an active relapse rather than reaching out for additional outpatient support.

Depending on whether you want to be this involved (and it is more than o.k. not to be), you could contact the treatment centre yourself to ask for advice. It might be a good place to start.

However, given that you also have undergone treatment, you also need to take good care of yourself first and foremost. Inpatient care is only the very beginning of recovery from anorexia and that means you are also particularly vulnerable to being around those actively relapsing.

We all have to be well enough ourselves to help others. In fact, one paediatrician who specializes in inpatient care for anorexics and bulimics specifically advises all former patients stay well away from helping other anorexics and bulimics. She prefers they focus on living their lives; normalizing their relationships with food as much as possible; and respecting the fact that it is a chronic condition prone to flare with the wrong stressors and inputs. I tend to agree with her.

Take very good care of yourself. Perhaps you can encourage your friend to check out the blog posts on my site as a way for her to come to her own "ah ha!" moment that she needs to dig out of the relapse as quickly as possible.

Best wishes, Gwyneth.

December 26, 2011 | Registered CommenterGwyneth