ST-segment changes and catecholamine-related myocardial enzyme release during alcohol withdrawal

Area of Science:

• Cardiology
• Internal Medicine
• Addiction Medicine

Background:

• Alcohol withdrawal is a common clinical syndrome.
• Cardiac complications during alcohol withdrawal are not fully understood.
• Sympatho-adrenergic activation is known to occur during alcohol withdrawal.

Purpose of the Study:

• To investigate ST-segment changes and biochemical markers of myocardial injury during alcohol withdrawal.
• To explore the relationship between these cardiac changes and sympatho-adrenergic activation.
• To assess cardiac function in alcohol-dependent men during withdrawal.

Main Methods:

• Case series of 19 alcohol-dependent men undergoing inpatient alcohol withdrawal treatment.
• 24-hour ambulatory electrocardiographic recordings to detect ST-segment changes.
• Measurement of serum creatine kinase (CKMB) and cardiac troponin T.
• Assessment of urinary adrenaline and noradrenaline excretion.
• Echocardiography to evaluate left ventricular ejection fraction.

Main Results:

• Seven out of 19 patients exhibited ST-segment depressions (> or = 0.1 mV).
• Serum CKMB concentrations correlated significantly with urinary adrenaline and noradrenaline excretion.
• Two patients with highest adrenaline excretion also showed ST-segment depressions and elevated cardiac enzymes.
• All 17 patients assessed by echocardiography had normal left ventricular ejection fraction (> or = 0.65).

Conclusions:

• Alcohol withdrawal is frequently associated with ST-segment abnormalities in men without apparent heart disease.
• Sympatho-adrenergic activation during withdrawal appears to influence myocardial enzyme release.
• Alcohol withdrawal should be considered a condition with potential for acute cardiac complications in susceptible individuals.