Increased QT interval variability index in acute alcohol withdrawal.
ABSTRACT Acute alcohol withdrawal is associated with increased cardiovascular mortality, most likely due to cardiac arrhythmias. As the QT interval reflects the most critical phase for the generation of reentry and thus for arrhythmia, we examined QT variability in patients suffering from acute alcohol withdrawal.
High resolution electrocardiographic recordings were performed in 18 male unmedicated patients suffering from acute alcohol withdrawal, 18 matched controls and 15 abstained alcoholics. From these, parameters of beat-to-beat heart rate and QT variability such as approximate entropy and QT variability index (QTvi) were calculated. Measures were correlated with the severity of withdrawal symptoms and with serum electrolyte concentrations.
Heart rate and QTvi were significantly increased in acute alcohol withdrawal. Abstained alcoholics did not significantly differ from controls. While QTvi correlated with the severity of alcohol withdrawal symptoms, the mean QT interval duration showed an inverse relationship with serum potassium concentrations.
Our data indicate increased QT variability and thus increased repolarization lability in acute alcohol withdrawal. This might add to the elevated risk for serious cardiac arrhythmias. In part, these changes might be related to increased cardiac sympathetic activity or low potassium, thus suggesting the latter as possible targets for adjuvant pharmacological therapy during withdrawal.
- SourceAvailable from: Saroj Jayasinghe[Show abstract] [Hide abstract]
ABSTRACT: The potential of alcohol withdrawal to cause acute coronary events is an area that needs the urgent attention of clinicians and researchers. We report the case of a 52-year-old heavy-alcohol-using Sri Lankan man who developed electocardiogram changes suggestive of an acute coronary event during alcohol withdrawal. Despite the patient being asymptomatic, subsequent echocardiogram showed evidence of ischemic myocardial dysfunction. We review the literature on precipitation of myocardial ischemia during alcohol withdrawal and propose possible mechanisms. Alcohol withdrawal is a commonly observed phenomenon in hospitals. However, the number of cases reported in the literature of acute coronary events occurring during withdrawal is few. Many cases of acute ischemia or sudden cardiac deaths may be attributed to other well known complications of delirium tremens. This is an area needing the urgent attention of clinicians and epidemiologists.Journal of Medical Case Reports 08/2011; 5:369. DOI:10.1186/1752-1947-5-369
- [Show abstract] [Hide abstract]
ABSTRACT: A 29-year-old patient diagnosed with (S,L,L) congenitally corrected transposition of great arteries (CCTGA) and pre-excitation is presented. We performed a coronary angiogram and it documented multiple coronary sinus rings in both mitral and tricuspid atrioventricular grooves, with multiple branches and right atrium fistulas. Note the venous retour shows a dual coronary venous system, with a remnant of the left superior venacava draining in the 'left' coronary sinus (white arrows) marking the level of the true AV groove, and a prominent 'right' coronary venous system at the 'right' AV groove fistulas (red arrow). Three accessory pathways were ablated. To our knowledge, this severe malformation of the coronary venous system has not been previously described. The full-length version of this report can be viewed at: http://www.escardio.org/communities/EHRA/publications/ep-case-reports/Documents/multiple-accessory-pathways.pdf.Europace 07/2013; 16(1). DOI:10.1093/europace/eut212 · 3.05 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: Background Alcohol withdrawal syndrome, characterized by confusion, agitation, and hallucinations, decreases the safety of patients with acute myocardial infarction. Unexpected hospitalization and sudden cessation of alcohol consumption may increase in-hospital complications and length of stay and even precipitate death. Purpose To perform a randomized evaluation of lorazepam and ethanol/lorazepam to evaluate the safety and efficacy of these 2 strategies for preventing alcohol withdrawal syndrome in patients with acute coronary syndromes. Methods Patients (n = 57) with myocardial infarction were screened for alcohol dependence by using the CAGE questionnaire and randomized to treatment with lorazepam or ethanol with lorazepam. Demographics and complication rates were analyzed by using χ(2) tests (categorical variables) and t tests (continuous variables). Safety (composite complication rates) of the treatment strategy was evaluated by using the Fisher exact test, and length of stay by using the Wilcoxon rank-sum test. Results Safety-associated complication rates (self-extubation, delirium tremens, reinfarction) did not differ between groups (24% lorazepam vs 18% ethanol; P = .56). Days spent in the cardiac intensive care unit (7% lorazepam vs 2% ethanol; P = .32) and overall hospital stay (6% lorazepam vs 6% ethanol; P = .72) did not differ between the 2 groups. Conclusions These preliminary findings suggest that a randomized evaluation of treatment strategies to prevent complications associated with alcohol withdrawal in patients with acute myocardial infarction is safe and feasible.American Journal of Critical Care 09/2013; 22(5):398-406. DOI:10.4037/ajcc2013283 · 1.60 Impact Factor
Michael Karl Boettger