[Acute transient left-ventricular systolic disfunction during alcohol withdrawal]

Stress cardiomyopathy is an acute transient left ventricular dysfunction, associated with emotional stress. In the course of alcohol withdrawal abnormalities of perfusion and myocardial contractility have been described, manifested in the scintigraphic study, with the absence of changes in ECG and echocardiography and probably caused by sympathicotony, in analogy to severe emotional stress. We present a case of acute left ventricular dysfunction during alcohol withdrawal with significant changes in echocardiography and ECG mimicking acute coronary syndrome. In a 53-year-old woman, treated in the internal ward because of abdominal pain, vomiting, and moderately elevated pancreatic amylase in serum and urine, chest pain and shortness of breath at rest occurred during the first day of hospitalization. These symptoms were accompanied by ST segment elevation in V2-V3, negative T waves in V2-V6 and an increase in troponin. Coronarography excluded significant changes in the arteries, the echocardiography revealed apical akinesis with left ventricular ejection fraction (LVEF) 30%. By hospital day 3 disorientation and behavior disorders corresponding of alcohol withdrawal appeared. In subsequent days improvement in LV systolic function was observed with LVEF increase to 53%. ECG changes in the form of a deep negative T waves in I, II, aVL and V2-V6 persisted to the end of hospitalization.