The Impact of Anorexia Nervosa on Cardiac Structure and Function: A Narrative Review of Myocardial Remodeling, Electrophysiological Alterations and Clinical Outcomes

Objective: Anorexia nervosa (AN) is associated with the highest mortality rate among psychiatric disorders, with cardiovascular complications representing one of the major causes of morbidity and death. This narrative review aimed to summarize current evidence regarding the effects of AN on cardiac structure and function, focusing on myocardial remodeling, electrophysiological abnormalities, and clinical outcomes. Methods: A narrative review methodology was employed using fourteen studies provided by the authors, including systematic reviews, observational studies, imaging studies, long-term follow-up investigations, and case reports published between 2005 and 2025. Data were synthesized qualitatively to identify recurring patterns of cardiovascular involvement. Results: The evidence consistently demonstrates that starvation-induced cardiac remodeling is characterized by reduced left ventricular mass, diminished chamber dimensions, decreased cardiac output, and occasional pericardial effusion. Electrophysiological manifestations include sinus bradycardia, altered autonomic balance with parasympathetic predominance, QT interval abnormalities, and increased susceptibility to potentially fatal arrhythmias, particularly in the context of electrolyte disturbances. Histopathological findings suggest the presence of myocardial fibrosis and myxoid degeneration in severe disease, although cardiac magnetic resonance studies indicate that diffuse replacement fibrosis may not be universal. Importantly, most structural and functional abnormalities appear to improve following nutritional rehabilitation and weight restoration. Nevertheless, persistent low body weight remains associated with long-term cardiac impairment and rare but devastating complications, including cardiogenic shock and sudden cardiac death. Conclusion: Recognition of cardiovascular involvement in AN is essential for risk stratification, timely intervention, and multidisciplinary management. Although the majority of cardiac abnormalities appear reversible with nutritional rehabilitation, severe or persistent disease may result in irreversible myocardial injury and life-threatening complications. Further prospective studies are needed to clarify the mechanisms underlying sudden cardiac death and to identify predictors of irreversible cardiac damage in this vulnerable population.