title: Inducible syncope in anorexia nervosa: two case reports.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Psychiatry, Johns Hopkins School of Medicine, Baltimore, Maryland, USA. kpiyaka@jhmi.edu
authors.forename: Katherine P
authors.initials: KP
authors.lastname: Buchowski
authors.forename: Jennifer
authors.initials: J
authors.lastname: Pardo
authors.forename: Richard
authors.initials: R
authors.lastname: Ringel
authors.forename: Angela S
authors.initials: AS
authors.lastname: Guarda
mesh_terms: D000293:Adolescent; D000856:Anorexia Nervosa / Q000453:epidemiology* / Q000503:physiopathology / Q000628:therapy; D015444:Exercise; D005260:Female; D006801:Humans; D008297:Male; D011311:Pressoreceptors / Q000502:physiology; D013575:Syncope / Q000453:epidemiology*; D014630:Vagus Nerve / Q000502:physiology