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.
"Propofol's ability to mediate the hemodynamic instability during alcohol withdrawal is paramount in patients refractory to BZ treatment and should be started promptly when recognized. There is documented variability of QT intervals and ST segment changes associated with withdrawals as well as increases in myocardial oxygen demand secondary to a catecholamine surge [10, 11]. QT variability can lead to re-entry tachycardia and is arrhythmogenic, especially with the electrolyte imbalance most alcoholics possess. "
[Show abstract][Hide abstract] ABSTRACT: Delirium tremens develops in a minority of patients undergoing acute alcohol withdrawal; however, that minority is vulnerable to significant morbidity and mortality. Historically, benzodiazepines are given intravenously to control withdrawal symptoms, although occasionally a more substantial medication is needed to prevent the devastating effects of delirium tremens, that is, propofol. We report a trauma patient who required propofol sedation for delirium tremens that was refractory to benzodiazepine treatment. Extubed prematurely, he suffered a non-ST segment myocardial infarction followed by an ST segment myocardial infarction requiring multiple interventions by cardiology. We hypothesize that his myocardial ischemia was secondary to an increased myocardial oxygen demand that occurred during his stress-induced catecholamine surge during the time he was undertreated for delirium tremens. This advocates for the use of propofol for refractory benzodiazepine treatment of delirium tremens and adds to the literature on the instability patients experience during withdrawal.
"In a case control study of human subjects Bar et al. have demonstrated that the QT interval is significantly prolonged in patients in acute alcohol withdrawal increasing the repolarization vulnerability of the myocardium. Authors assume that this prolongation is related to the sympathetic over activity during withdrawal . The phenomenon of QT interval prolongation during alcohol withdrawal has also been investigated by Cuculi et al. . "
[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: ñ The article presents a review of current research on the influence of substitution drugs (LAAM, methadone, buprenorphine) on heart muscle repolarization (QTc prolongation). Results show that LAAM can cause QTc prolongation and increase the risk of tachyarrythmia (torsade de pointes ñ TdP), which may lead to severe symptoms such as collapse or even to sudden death. That was presented as a reason to withdraw LAAM from the pharmaceutical market. Consequently, interest about potentially similar effects of methadone on heart muscle repolariza- tion arose. It was confirmed that methadone may potentially cause QTc prolongation and lead to TdP. More specifically the following risk factors of QTc prolongation in methadone patients are observed: high methadone dose, high methadone plasma concentration, drugs pharmacokinetically interacting with methadone (CYP3A4), HIV infection, hypokalemia, liver cirrhosis, kidney insufficiency, and alco- hol withdrawal. Some authors put emphasis on a synergism of risk factors. In order to avoid severe circulation side effects (QT prolongation, TdP) the following recommenda- tions are forwarded: ECG assessment before admission to methadone substitution therapy, monitor- ing of ECG during treatment with methadone, avoidance of drugs that can interact with methadone. When QT prolongation appears methadone dose should be decreased.
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