{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T15:50:55Z","timestamp":1790351455653,"version":"4.1.0"},"reference-count":24,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2025,6,5]],"date-time":"2025-06-05T00:00:00Z","timestamp":1749081600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Cardiogenic shock is a life-threatening condition characterized by the failure of the heart to maintain adequate circulation, leading to multi-organ dysfunction. While it is most commonly associated with acute myocardial infarction or cardiomyopathies, cardiogenic shock can also arise in unusual settings, such as severe malnutrition in patients with anorexia nervosa, a psychiatric disorder characterized by extreme restriction of food intake. Methods: Here, we describe the management of three patients with anorexia nervosa and severe cardiogenic shock, who were treated in our cardiological intensive care unit between December 2022 and January 2025. Two patients were successfully resuscitated after experiencing cardiac arrest, and two required mechanical circulatory support, including Venoarterial Extracorporeal Membrane Oxygenation and microaxial flow pump. The patients presented with a range of complications including multi-organ failure and respiratory distress. Due to the fragile balance between intensive cardiac and nutritional management, as well as the comorbidity of chronic malnutrition, therapeutic decisions were made carefully, including cautious electrolyte management, targeted nutritional therapy, and the use of advanced circulatory support. Conclusions: The treatment approach and beneficious outcomes underline the necessity of a multidisciplinary strategy in managing these critically ill patients with complex, interwoven pathologies. Our experience suggests that early recognition of cardiogenic shock and timely intervention with mechanical circulatory support may significantly improve patient survival in this high-risk cohort. Careful management of nutritional therapy and supplementation of trace elements and vitamins is crucial.<\/jats:p>","DOI":"10.3390\/jcm14114011","type":"journal-article","created":{"date-parts":[[2025,6,6]],"date-time":"2025-06-06T03:52:28Z","timestamp":1749181948000},"page":"4011","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["The Hungry Heart: Managing Cardiogenic Shock in Patients with Severe Anorexia Nervosa\u2014A Case Report Series"],"prefix":"10.3390","volume":"14","author":[{"given":"Manuela","family":"Thienel","sequence":"first","affiliation":[{"name":"Department of Cardiology, Ludwig-Maximilians-University Hospital, Ludwig Maximilians University, 81377 Munich, Germany"},{"name":"DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, 80336 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1750-3395","authenticated-orcid":false,"given":"Rainer","family":"Kaiser","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Ludwig-Maximilians-University Hospital, Ludwig Maximilians University, 81377 Munich, Germany"},{"name":"DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, 80336 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonas","family":"Gmeiner","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Ludwig-Maximilians-University Hospital, Ludwig Maximilians University, 81377 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Orban","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Ludwig-Maximilians-University Hospital, Ludwig Maximilians University, 81377 Munich, Germany"},{"name":"Kardiologie Ammer-Lech, 86911 Die\u00dfen am Ammersee, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"K\u00e4\u00e4b","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Ludwig-Maximilians-University Hospital, Ludwig Maximilians University, 81377 Munich, Germany"},{"name":"DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, 80336 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tobias","family":"Petzold","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charit\u00e9, University Hospital Berlin, Campus Benjamin Franklin, 12203 Berlin, Germany"},{"name":"DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, 10785 Berlin, Germany"},{"name":"Friede Springer, Centre of Cardiovascular Prevention at Charit\u00e9, Charit\u00e9 University Medicine Berlin, 12203 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steffen","family":"Massberg","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Ludwig-Maximilians-University Hospital, Ludwig Maximilians University, 81377 Munich, Germany"},{"name":"DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, 80336 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2816-6793","authenticated-orcid":false,"given":"Clemens","family":"Scherer","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Ludwig-Maximilians-University Hospital, Ludwig Maximilians University, 81377 Munich, Germany"},{"name":"DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, 80336 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,6,5]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"308","DOI":"10.1093\/ajcn\/77.2.308","article-title":"Reduced hemodynamic load and cardiac hypotrophy in patients with anorexia nervosa","volume":"77","author":"Romano","year":"2003","journal-title":"Am. 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