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Challenges in Clinical Electrocardiography
April 16, 2018

Electrocardiographic Changes in a Woman With Anorexia Nervosa

Author Affiliations
  • 1Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
  • 2Department of Medicine, Massachusetts General Hospital, Boston
JAMA Intern Med. Published online April 16, 2018. doi:10.1001/jamainternmed.2018.0981

A woman in her mid-30s with long-standing anorexia nervosa complicated by a history of cardiac arrests presented to the emergency department with chest pain and persistent weight loss. Physical examination revealed cachexia and mild diffuse abdominal tenderness; the cardiac examination was unremarkable. Her weight was 40.5 kg, with a body mass index (calculated as the weight in kilograms divided by height in meters squared) of 14. Laboratory testing revealed a glucose level of 40 mg/dL, a serum potassium level of 2.7 mEq/L, and a serum magnesium level of 2.1 mg/dL. The troponin T level was less than 0.01 ng/mL. (To convert the glucose level to millimoles per liter, multiply by 0.0555; serum potassium level to millimoles per liter, multiply by 1; serum magnesium level to millimoles per liter, multiply by 2.4; and troponin T level to micrograms per liter, multiply by 1.) An electrocardiogram (ECG) was obtained and is shown in Figure 1.

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