Inducible Syncope in Anorexia Nervosa: Two Case Reports

Objective: Syncope is a potentially dangerous symptom of anorexia nervosa that is usually attributed to bradycardia, dehydration, or hypoglycemia. Methods: This study describes two adolescents, one male and one female, with recurrent self-induced syncope associated with isometric exercise. Results: In one patient, Holter monitoring showed that isometric exercise led to increasing bradycardia followed by asystolic pauses accompanied by presyncopal symptoms. Discussion: We hypothesize that inducible syncope in these two patients is due to increased vagal tone and baroreceptor sensitivity. Physicians should be aware that patients with anorexia nervosa may be able to induce syncope with isometric exercise and that this potentially dangerous behavior needs to be addressed during treatment.