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Low Weight, Low Rate

During shift you are contacted by the ward nurse because with regard to bradycardia of a 12 years old girl. She was admitted for anorexia nervosa and has no prior heart condition. The patient is asymptomatic and does not take any drugs.

While sitting on the bed watching TV the ECG monitor shows the picture below:

The patient is completely asymptomatic und responds appropriately. The monitor ECG shows a heart rate of 30 bpm. Sinus rhythm is present. The girls BMI is 12. Bradycardia regularly appears in anorexia patients and is considered a response to energy depletion.

The 12-lead ECG shows the following:

Sinus rhythm, 42 bpm, PR 180-190ms, narrow QRS, no QTc prolongation.

When encountering anorexia patients showing bradycardia:

Usually no specific therapy is indicated. Patients may develop AV block I and II/1 (Wenckebach periodicity). However, device implantation (pacemaker) should be restricted to high grade AVB.

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