Anorexia nervosa and sudden death

Necropsy findings and electrocardiograms from three women with anorexia nervosa were reviewed. Necropsy examination failed to establish an anatomic cause of death. Electrocardiograms recorded days or less before death showed various degrees of Q-T interval prolongation: Q-T intervals corrected for heart rate measured 0.61 s, 0.47 s, and 0.46 s, respectively. Terminal ventricular tachyarrhythmias were documented in two patients, including torsade de pointes in one. The necropsy and clinical findings in these three cases provide evidence that sudden death in anorexia nervosa, like sudden death in liquid-protein dieting, may result from ventricular tachyarrhythmias related to Q-T interval prolongation. For such patients, electrocardiographic monitoring should be routine.