Increased Precautions We're Taking in Response to COVID-19

LAST UPDATED ON 12/17/2020

As updates on the impact of the coronavirus continue to be released, we want to take a moment to inform you of the heightened preventative measures we have put in place at McCallum Place Eating Disorder Center to keep our patients, their families, and our employees safe. All efforts are guided by and in adherence to the recommendations distributed by the CDC.

Please note that for the safety of our patients, their families, and our staff, on-site visitation is no longer allowed at McCallum Place Eating Disorder Center.

  • This restriction has been implemented in compliance with updated corporate and state regulations to further reduce the risks associated with COVID-19.
  • Options for telehealth visitation are continuously evaluated so that our patients can remain connected to their loved ones.
  • Alternate methods of communication for other services may be offered when deemed clinically appropriate.

For specific information regarding these changes and limitations, please contact us directly.

CDC updates are consistently monitored to ensure that all guidance followed is based on the latest information released.

  • All staff has received infection prevention and control training.
  • Thorough disinfection and hygiene guidance has been provided.
  • Patient care supplies such as masks and hand sanitizer are being monitored and utilized.
  • Temperature and symptom screening protocols are in place for all patients and staff.
  • Social distancing strategies have been implemented to ensure that patients and staff maintain proper distance from one another at all times.
  • Cleaning service contracts have been reviewed for additional support.
  • Personal protective equipment items are routinely checked to ensure proper and secure storage.
  • CDC informational posters are on display to provide important reminders on proper infection prevention procedures.
  • We are in communication with our local health department to receive important community-specific updates.

The safety of our patients, their families, and our employees is our top priority, and we will remain steadfast in our efforts to reduce any risk associated with COVID-19.

The CDC has provided a list of easy tips that can help prevent the spread of the coronavirus.

  • Avoid close contact with people who are sick.
  • Cover your cough or sneeze with a tissue and then immediately dispose of the tissue.
  • Avoid touching your eyes, nose, and mouth.
  • Clean and disinfect objects and surfaces that are frequently touched.
  • Wash your hands often with soap and water for at least 20 seconds.
  • Stay home when you are sick, except to get medical care.

For detailed information on COVID-19, please visit https://www.cdc.gov/coronavirus/2019-ncov/index.html

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Cardiovascular Complications of Eating Disorders

Cardiovascular complications of eating disorders are common and can be very serious.  They may present with chest pain.  It is important to determine if this symptom is coming from the heart or from another cause such as gastroesophageal reflux, muscular strain or anxiety.  As patients with anorexia lose weight, they lose muscle mass, both of the skeletal and cardiac type.  When patients lose cardiac muscle mass, they can develop mitral valve prolapse.  This can give the symptom of sharp pain beneath the sternum.  It is a benign condition which can improve with weight gain.  Chest pain could also be from a much more ominous cause – heart failure.  A very weakened heart could result in congestive heart failure.  Heart failure could also be the result of very low serum phosphorus in the refeeding syndrome.  If properly treated, heart failure does have the potential to improve.  Other symptoms associated with heart failure are shortness of breath, fatigue, tachycardia or a relative tachycardia, and edema.

Anorexia nervosa does have a high risk of death – about half of the deaths are sudden cardiac deaths.  These are the result of cardiac arrhythmias.  Why patients with eating disorders are prone to sudden cardiac death is not known for certain.  Prolonged QT intervals on electrocardiogram (ECG) predispose patients to a type of arrhythmia called torsade de pointes, which then can degenerate to a deadly arrhythmia known as ventricular fibrillation.  Prolonged QT can be a result of quick weight loss or severe weight loss.  It can also be a result of electrolyte disturbances (specifically low potassium and low magnesium) and certain medications.  In the case of a patient with anorexia, it may be a combination of these factors.  QT dispersion has also been noted in patients with anorexia nervosa and seems to put patients with this finding at higher risk of sudden cardiac death.  This is a variation in the QT interval between the leads of the ECG.  It is not known why this happens in patients with anorexia, but may have to do with myofibrillar degeneration, a finding that has been seen in anorexic patients on heart MRI.  This refers to degeneration of the cardiac muscle fibers.

Cardiomyopathy, or literally sick heart, can be caused in eating disorders by starvation or by the chronic use of emetics such as ipecac.  Fortunately, ipecac has been taken off the market so this cause is seen much less in the United States.  Chronic alcohol abuse, which can be comorbid with eating disorders, is also a cause of cardiomyopathy.  Certain nutritional deficiencies are also rarely known to cause cardiomyopathy (magnesium and thiamine are examples).  Severe cardiomyopathy can lead to heart failure or be a risk factor for a heart arrhythmia.

Bradycardia or heart rate less than 60 beats per minute and hypotension or blood pressure less than 90/50 are very common in anorexia nervosa, in patients who are less than 80% of ideal body weight.  The bradycardia is due to an overactive parasympathetic nervous system, in the body’s attempt to conserve energy. The hypotension is due to the weakened heart muscle.  Dehydration can also be a contributor to hypotension.  If the patient’s bradycardia is severe, i.e. less than 40 bpm and accompanied by hypotension, the patient should be hospitalized for monitoring.  If the patient with bradycardia develops a rhythm other than sinus rhythm on the ECG, this is also a reason for hospitalization for monitoring.  These problems can be alleviated by good nutrition and weight gain.

n normal weight patients with eating disorders, such as those with bulimia nervosa, the biggest cardiac risk is that of having an arrhythmia due to an electrolyte abnormality, such as low serum potassium or low serum magnesium.

In overweight or obese patients with eating disorders, the cardiac risk of having low potassium if the patient purges is still present.  Moreover, in obese patients with eating disorders, such as binge eating disorder, the risks of hypercholesterolemia, hypertension and diabetes are high.  All of these can lead to cardiac complications such as atherosclerotic heart disease and congestive heart failure.

Cardiovascular complications in eating disorders are very common.  Unfortunately, the presence of untreated eating disorders and severe eating disorders greatly increases the patient’s risk of morbidity and mortality from these cardiovascular complications.     Fortunately, most of them are reversible or at least treatable with proper medical eating disorder treatment of good nutritional rehabilitation and attention to the vascular status and electrolyte status of the individual.

References:

Birmingham, CL and Treasure, J. Medical Management of Eating Disorders. Cambridge University Press,2010.

Mehler, PS and Andersen, AE. Eating Disorders:  A Guide to Medical Care and Complications – 2nd ed. The Johns Hopkins University Press, 2010.

Myatt, R. “An overview of cardiac risk in patients with chronic eating disorders” British Journal of Cardiac Nursing, Vol 9 No 6, pp 287-291, June, 2014.

Oflaz, S, et al. “Assessment of Myocardial Damage by Cardiac MRI in Patients with Anorexia Nervosa” Int Journal of Eating Disorders, Vol 46 Issue 8, pp 862-866, Dec, 2013.

Article by Caroline Rudnick

Test Dr. Caroline Rudnick is a board-certified family physician and has been in practice for 15 years. She completed her MD and PhD at Washington University in St. Louis and her family medicine residency at St. John’s Mercy Medical Center in St. Louis. She is currently on faculty at St. Louis University in the department of Family Medicine where she teaches the medical students general medical topics as well as eating disorders.