ECG changes in alcoholic intoxication

Česká verzia

Authors: K. Trejbal; P. Mitro
Authors place of work: III. interná klinika Lekárskej fakulty UPJŠ a FN L. Pasteura Košice, Slovenská republika, prednosta doc. MUDr. Peter Mitro, Ph. D.
Published in the journal: Vnitř Lék 2008; 54(4): 410-414
Category: Review

Summary

Patients with acute alcohol intoxication often present with pathological electrocardiographic (ECG) changes. The changes are more frequent and prognostically more significant in chronic alcoholics, in patients with ischaemic heart disease (IHD), in alcohol cardiomyopathy or another organic heart disease, but they can also occur in young and healthy individuals. The typical ECG changes in inebriety are disturbances of heart rate having the nature of electric impulse generation disorder or of impulse conduction pathology. In persons without clinical evidence of heart disease, they are classified as 'holiday heart syndrome’. The most frequent tachyarrhythmia is atrial fibrillation; less frequent but prognostically much more significant is torsades de pointes (TdP) polymorphous ventricular tachycardia. Among bradyarrhythmias, the most significant is alcohol-induced sinus bradycardia which may be manifested by recurrent syncope. The higher the blood alcohol concentration, the higher the occurrence of a significant extension of ECG intervals with possible manifestation of latent conduction disturbance or even sudden cardiac death. Apart from heart rate disturbances, ECG picture very often shows non-specific repolarisation changes. Ischaemia, which is mostly asymptomatic in the form of silent myocardial ischaemia, is worsened in alcohol-intoxicated IHD patients. The resulting ECG may be to a large extent influenced by states which often associate with inebriety, such as hypothermia, hypoglycaemia or electrolyte imbalance. ECG changes similar to those due to acute alcohol intoxication are also present in acute abstinence syndrome, especially in delirium tremens. There is convincing evidence that not only chronic alcoholism, but also single episodes of excessive alcohol consumption are associated with increased cardiovascular mortality.

Key words:
ethanol intoxication – holiday heart syndrome – atrial fibrillation – torsades de pointes

Zdroje

1. The Merck Manual of Geriatrics. (Selection 8 - Metabolic and Endocrine Disorders, Chapter 67 - Hyperthermia and Hypothermia). 2006

2. Aasebo W, Erikssen J, Jonsbu J et al. ECG changes in patients with acute ethanol intoxication. Scand Cardiovasc J 2007; 41: 79-84.

3. Bostaca I, Ciurea AM, Ciurea O. Alcoholic Torsades de Pointes. <http://web.archive.org/web/20050510041739/http://www.fac.org.ar/tcvc/llave/tl201/tl201.htm>

4. Buckingham TA, Kennedy HL, Goenjian AK et al. Cardiac arrhythmias in a population admitted to an acute alcoholic detoxification center. Am Heart J 1985; 110: 961-965.

5. Budzikowski AS, Daubert JP, Smith RH et al. Holiday Heart Syndrome. http://www.emedicine.com/med/topic1024.htm

6. Cuculi F, Kobza R, Ehmann T et al. ECG changes amongst patients with alcohol withdrawal seizures and delirium tremens. Swiss Med Wkly 2006; 136: 223-227.

7. Davidson DM. Cardiovascular effects of alcohol. West J Med 1989; 151: 430-439.

8. Denison H, Jern S, Jagenburg R et al. ST-segment changes and catecholamine-related myocardial enzyme release during alcohol withdrawal. Alcohol Alcohol 1997; 32: 185-194.

9. Dobiáš V. Repetitórium urgentnej medicíny - Bezvedomie neúrazového pôvodu. Via Pract 2005; 2: 417-420.

10. Ferlitsch A, Kreil A, Bauer E et al. Bradycardia and sinus arrest during percutaneous ethanol injection therapy for hepatocellular carcinoma. Eur J Clin Invest 2004; 34: 218-223.

11. Klatsky AL. Alcohol and cardiovascular diseases: a historical overview. Novartis Found Symp 1998; 216: 2-12.

12. Lins M, Petersen B, Tiroke A et al. Reversible electrocardiographic changes in hypothermia. Z Kardiol 2004; 93: 630-633.

13. Lorsheyd A, De Lange DW, Hijmering ML et al. PR and QTc interval prolongation on the electrocardiogram after binge drinking in healthy individuals. Neth J Med 2005; 2: 59-63.

14. Lowenstein SR, Gabow PA, Cramer J et al. The role of alcohol in new-onset atrial fibrillation. Arch Intern Med 1983; 143: 1882-1885.

15. Matsuguchi T, Araki H, Anan T et al. Provocation of variant angina by alcohol ingestion. Eur Heart J 1984; 5: 906-912.

16. Meinhold J, Heise T, Rave K et al. Electrocardiographic changes during insulin - induced hypoglycemia in healthy subjects. Horm Metab Res 1998; 30: 694-697.

17. Rauchenzauner M, Kountchev J, Ulmer H et al. Disturbances of electrolytes and blood chemistry in acute alcohol intoxication. Wien Klin Wochenschr 2005; 117: 83-91.

18. Rich EC, Siebold C, Campion B Alcohol-related acute atrial fibrillation. A case-control study and review of 40 patients. Arch of Intern Med 1985; 145: 830- 833.

19. Rossinen J, Partanen J, Koskinen P et al. Acute heavy alcohol intake increases silent myocardial ischaemia in patients with stable angina pectoris. Heart 1996; 75: 563-567.

20. Rossinen J, Sinisalo J, Partanen J et al. Effects of acute alcohol infusion on duration and dispersion of QT interval in male patients with coronary artery disease and healthy controls. Clin Cardiol 1999; 22: 591-594.

21. Oda H, Suzuki M, Oniki T et al. Alcohol and coronary spasm. Angiology 1994; 45: 187-197.

22. Tateoka K, Iwasaki Y, Ono T et al. A new alcohol provocation head up tilt protocol in the patients with alcohol-related syncope. Europace 2007; 9: 220-224.

23. Tsutsui M, Matsuguchi T, Tsutsui H et al. Alcohol-induced sinus bradycardia and hypotension in patients with syncope. Jpn Heart J 1992; 33: 875-879.

24. Uyarel H, Özdöl C, Karabulut A et al. Acute alcohol intake and P - wave dispersion in healthy men. Anadolu Kardiyol Derg 2005; 5: 289-293.

25. Williams MJA, Restieaux NJ, Low CJS Myocardial infarction in young people with normal coronary arteries. Heart 1998; 79: 191-194.

26. Zipes DP, Camm AJ, Borggrefe M et al. ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death. J Am Coll Cardiol 2006; 48: 247-346.