title: Cardiac tamponade in association with anorexia nervosa: a case report and review of the literature.
abstract: Anorexia nervosa (AN) is a complex psychiatric disorder that can have devastating cardiovascular  complications. Its lesser-known association with pericardial effusion has been recently  described in the literature. We present the case of a 45 year-old female who presented with  a recurrent small bowel obstruction requiring lysis of adhesions and who was found to have  a large pericardial effusion that progressed to cardiac tamponade necessitating surgical intervention.  The patient had a body mass index of 14.8 kg/m2 (i.e. 71% of ideal body weight) and  a long-standing history of food aversion, extreme exercise habits, and weight obsession consistent  with AN. To the best of our knowledge, this is the first case of AN-associated cardiac  tamponade in the United States, and the first requiring surgical intervention. In conclusion,  with this and current data regarding AN-associated pericardial effusions, we recommend  a low threshold for performing pre-operative echocardiography for those in whom AN is suspected.
authors.affiliation: Department of Medicine, Walter Reed National Military Medical Center, Bethesda, MD, USA.
authors.forename: Jacqueline N
authors.initials: JN
authors.lastname: Kircher
authors.forename: Matthew H
authors.initials: MH
authors.lastname: Park
authors.forename: Michael K
authors.initials: MK
authors.lastname: Cheezum
authors.forename: Edward A
authors.initials: EA
authors.lastname: Hulten
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Kunz
authors.forename: Mark
authors.initials: M
authors.lastname: Haigney
authors.forename: J Edwin
authors.initials: JE
authors.lastname: Atwood
mesh_terms: D000856:Anorexia Nervosa / Q000150:complications*; D015992:Body Mass Index; D002305:Cardiac Tamponade / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000150:complications / Q000473:pathology / Q000601:surgery; D007421:Intestine, Small / Q000473:pathology / Q000601:surgery; D008875:Middle Aged; D010490:Pericardial Effusion / Q000150:complications / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D012307:Risk Factors; D016896:Treatment Outcome; D014463:Ultrasonography