Anorexia and Slow Heartbeat: Is a Pacemaker Needed? December 31, 2022
December Research Highlights
A recent case study led by a Philadelphia College of Osteopathic Medicine student
raises awareness to a case of asymptomatic sinus bradycardia—or a very slow heart
rate, in this instance in the range of 20 to 30 beats per minute—and details clinical
decision-making as to whether a pacemaker would be warranted in this circumstance.
John Pueringer (DO ’23) was first author of “A Case of Profound Bradycardia in Endurance Athlete with Severe Anorexia Nervosa,” published in the journal Case Reports in Cardiology, which outlines the case of a woman in her 50s with severe chronic sinus bradycardia
(a slow heart rate—hers was 33 beats per minute) and anorexia nervosa.
The patient was referred for potential pacemaker implantation after being admitted
to the hospital. Common indicators for permanent pacemaker implantation are sinus
node dysfunction and high-grade atrioventricular block, according to the authors.
Recognizing that bradycardia is common in anorexia and that the use of a pacemaker
“is rarely or never required” without symptoms in that circumstance, the authors concluded
that, for “our patient, the absence of symptoms, ventricular arrhythmia or structural
heart disease, and owing to normal ventricular function, we felt that permanent pacemaker
implantation was unnecessary.”
“In many scenarios, a very low heart rate is dangerous and considered pathologic and
may be treated with a pacemaker to avoid sudden death or cardiac arrest,” Pueringer
said. “But in the absence of symptoms, ventricular arrhythmia or structural heart
disease, and owing to normal ventricular function, a permanent pacemaker implantation
is not recommended because they are at their baseline and it is not causing any problems
or structurally inclined to cause problems.”
Student Research at PCOM
Pueringer said he’s interested in research because it serves as an avenue to learn
about and keep up with medical advances and treatment guidelines, including pathophysiology,
diagnostics, diagnosis, treatment, and follow-up.
His advice to other medical students pursuing research: Be self-directed and suggest
your own projects, hypotheses, or cases, and then ask physicians to mentor your work.
“Many of the case reports I completed were primarily self-directed projects with PCOM-affiliated
attending physicians at partner sites,” Pueringer said, specifically citing PCOM Otolaryngology-Head
and Neck Surgery for “their inclusion, mentorship and patience in teaching me throughout
the past couple years.”
December 2022 Research Highlights at PCOM
Faculty, staff and students at the College's three locations frequently participate
in innovative research studies in a variety of topics including the opioid crisis,
COVID-19, medical cannabis, surgery, mental health and much more. The overall goal
of PCOM research is to develop and test novel approaches to diagnosing, treating and preventing dysfunction
View more PCOM research highlights for the month of December:
Julia T. Boyle, PsyD ’20; Bradley Rosenfield, PsyD, practicum coordinator, clinical psychology; and Robert A. DiTomasso, PhD, dean, School of Professional and Applied Psychology, co-authored “Sleep Continuity,
Sleep Related Daytime Dysfunction, and Problem Endorsement: Do These Vary Concordantly
by Age?,” which was published in the journal Behavioral Sleep Medicine.
Yash Chaudhry, DO, resident, orthopedic surgery, co-authored “Predictors of Hospice Discharge After
Surgical Fixation of Hip Fractures,” which was published in the Journal of American Academy of Orthopedic Surgeons.
Eric Cyphers (DO ’23) was first author of “Inclusive Resident Selection in Radiology: Practices for Interviewers,”
which was published in the Journal of the American College of Radiology.
Valerie Foy (DO ’23) co-authored “Epidemiology And Clinical Presentation Of Pediatric-Onset Versus Adult-Onset
Atopic Dermatitis,” which was published in the British Journal of Dermatology.
Bryan Klapes (DO ’24) co-authored “A Test Of The Evolutionary Theory's Account Of Punishment Superimposed
On Single-Alternative Schedules,” which was published in the Journal of Experimental Analysis of Behavior. Klapes also co-authored “Examining Resurgence And Repetition With The Evolutionary
Theory Of Behavior Dynamics,” which was published in the journal Behavioural Processes.
Tanner Lyons, DO, resident, otolaryngology, was first author of “Endolymphatic Sac Tumor,” which was
published in the Ear, Nose and Throat Journal.
John Pueringer (DO ’23) was first author of “A Case of Profound Bradycardia in Endurance Athlete with Severe
Anorexia Nervosa,” which was published in the journal Case Reports in Cardiology.
Scott Serpico (DO ’23) co-authored “Suicide Among Liver Transplant Patients,” which was published in the
Monali Shah (DO ’23) was first author of “Preoperative splenic artery embolization for splenic ectopic
pregnancy,” which was published in the journal Radiology Case Reports. Shah also co-authored “Defining the Reliability of Bladder Scan in Obese Patients
with Postoperative Urinary Retention,” which was published in the Journal of the American College of Surgeons.
Nathan Somerset, DO, resident, internal medicine, co-authored “An Atypical Presentation of Myxedema Coma
Masked by Underlying Renal Failure,” which was published in the journal Thyroid.
Urmiya Rashid, DO ’20, resident, internal medicine, co-authored “Antineutrophil Cytoplasmic Autoantibody-Associated
Glomerulonephritis as a Possible Side Effect of COVID-19 Vaccination,” which was published
in the journal Cureus.
Dianzheng Zhang, PhD, professor, biochemistry and molecular biology, co-authored “Genetic Profiling Of
Hormone-Sensitive And Castration-Resistant Prostate Cancers And Identification Of
Genetic Mutations Prone To Castration-Resistant Prostate Cancer,” which was published
in the journal Prostate Cancer and Prostatic Diseases.
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