A rare case of acute alcohol intoxication mimicking an electrocardiographic pattern for acute coronary syndrome with ST-segment elevation

Submitted: 1 October 2019
Accepted: 20 December 2019
Published: 15 April 2020
Abstract Views: 1127
PDF: 394
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

Authors

A patient presenting an ST-segment elevation could represent a life-threatening condition in Emergency Department (ED). This case shows how sometimes, a chronic, and more often, an acute abuse of alcohol is related to important harmful effects on myocardial contractility. The authors present a case of a 19-year-old male of oriental-Asiatic origin admitted unconscious to ED with alcoholic fetor: on electrocardiogram a significant and widespread STsegment elevation was observed. A bedside echocardiography showed no abnormalities in segmental kinetics; therefore electrocardiogram- alterations could be related to a coronary spasm. The literature is poor about this effect induced by acute alcohol ingestion: the pathophysiological mechanism at the base of the abnormal muscle contractility, seems to be related to an impairment in cyclic guanosine monophosphate production, although a second and less probable hypothesis could be an altered intracellular concentration of calcium levels.

Dimensions

Altmetric

PlumX Metrics

Downloads

Download data is not yet available.

Citations

Takehana H, Izumi T. [Alcoholic heart disease]. [Article in Japanese]. Nihon Rinsho. 2000 Jan;58(1):151-6.
Brawnwald E. Heart Disease: A Textbook of Cardiovascular Medicine. 5th edition (Ed. By Brawnwald E.). Philadelphia. W.B. Saunders Company. 1997; 1412-1414
Suzuki K, Osada N, Akasi YJ et al. An atypical case of "Takotsubo cardiomyopathy" during alcohol withdrawal: abnormality in the transient left ventricular wall motion and a remarkable elevation in the ST segment. Intern Med. 2004 Apr;43(4):300-5.
Ahmed SS, Levinson GE, Regan TJ. Depression of myocardial contractility with low doses of ethanol in normal man. Circulation. 1973 Aug;48(2):378-85.
Ahmed SS, Levinson GE, Regan TJ. Depression of myocardial contractility with low doses of ethanol in normal man. Circulation. 1973 Aug;48(2):378-85. DOI: https://doi.org/10.1161/01.CIR.48.2.378
Maguire R. Acute dilatation of the heart produced by alcoholism. Br Med J 1887; 1 : 1215
Niccoli G, Altamura L, Fabretti A, et al. Ethanol abolishes ischemic preconditioning in humans. J Am Coll Cardiol. 2008 Jan 22;51(3):271-5. doi: 10.1016/j.jacc.2007.09.042.
Feng Xu, Yu Guo Chen, Li Xue et al. Role of aldehyde dehydrogenase 2 Glu504lys polymorphism in acute coronary syndrome. J. Cell. Mol. Med. 2011 Vol 15, No 9, pp. 1955-1962.
Mizuno Y, Hokimoto S, Harada E, et al.Variant Aldehyde Dehydrogenase 2 (ALDH2*2) Is a Risk Factor for Coronary Spasm and ST-Segment Elevation Myocardial Infarction. J Am Heart Assoc. 2016 May 6;5(5). pii: e003247. doi: 10.1161/JAHA.116.003247. DOI: https://doi.org/10.1161/JAHA.116.003247
Maguire R. Acute dilatation of the heart produced by alcoholism. Br Med J 1887; 1 : 1215
Ettinger PO, Wu CF, De la Cruz C et al. “Arrhythmias and the holiday Heart”: alcohol-associated cardiac rhythm disorders” Am. Heart J. 95 (5): 555-62.) (10) DOI: https://doi.org/10.1016/0002-8703(78)90296-X
Niccoli G, Altamura L, Fabretti A et al. Ethanol abolishes ischemic preconditioning in humans. J Am Coll Cardiol. 2008 Jan 22;51(3):271-5. doi: 10.1016/j.jacc.2007.09.042. DOI: https://doi.org/10.1016/j.jacc.2007.09.042
Correale M, Laonigro I, Altomare E, Di Biase M. [Alcohol-induced cardiac disease]. G Ital Cardiol (Rome). 2009 Jan;10(1):18-27. Review. Italian.
Feng Xu, Yu Guo Chen, Li Xue et al. Role of aldehyde dehydrogenase 2 Glu504lys polymorphism in acute coronary syndrome. J. Cell. Mol. Med. Vol 15, No 9, 2011 pp. 1955-1962. DOI: https://doi.org/10.1111/j.1582-4934.2010.01181.x
Ando H, Abe H, Hisanou R. Ethanol-induced myocardial ischemia: close relation between blood acetaldehyde level and myocardial ischemia. Clin Cardiol 1993; 16:443-446. DOI: https://doi.org/10.1002/clc.4960160514
Altura BM, Altura BT e Carella A. Ethanol produces coronary vasospasm: evidence for a direct action of ethanol on vascular muscle. Br J Pharmacol. 1983 Feb;78(2):260-2. DOI: https://doi.org/10.1111/j.1476-5381.1983.tb09389.x
Miwa K, Igawa A, & Miyagi Y: Importance of magnesium deficiency in alcohol-induced variant angina. Am J Cardiol 1994; 73:813-816. DOI: https://doi.org/10.1016/0002-9149(94)90886-9
Puddey IB, Zilkens RR, Croft KD, Beilin LJ. Alcohol and endothelial function: a brief review. Clin Exp Pharmacol Physiol. 2001 Dec;28(12):1020-4. DOI: https://doi.org/10.1046/j.1440-1681.2001.03572.x
Brizzolara AL, Morris DG, Burnstock G. Alcohol affects sympathetic cotransmission and endothelium-dependent relaxation in the rat. Eur. J. Pharmacol. 1994; 254: 175–81.
Hatake K, Wakabayashi I, Kakishita E et al. Inhibitory effect of alcohol on endothelium-dependent vascular responsiveness. Eur. J. Pharmacol. 1989; 168: 277–83.
Yasue H, Kugiyama K (2000) Coronary artery spasm. Clinical features, pathogenesis and treatment. In: Yasue H (ed) Coronary artery spasm. Springer, Berlin Heidelberg New York Tokyo, pp 9– 18
Oda H, Suzuki M, Oniki T et al. Alcohol and coronary spasm. Angiology.1994 Mar;45(3):187-97. DOI: https://doi.org/10.1177/000331979404500303
Suzuki K, Osada N, Akasi YJ, Suzuki N, Sakakibara M, Miyake F, Maki F, Takahashi Y. An atypical case of "Takotsubo cardiomyopathy" during alcohol withdrawal: abnormality in the transient left ventricular wall motion and a remarkable elevation in the ST segment. Intern Med. 2004 Apr;43(4):300-5. DOI: https://doi.org/10.2169/internalmedicine.43.300

How to Cite

Lai, F., Pelagatti, L., Pagnini, C., Baldini, A., Versari, D., & Magazzini, S. (2020). A rare case of acute alcohol intoxication mimicking an electrocardiographic pattern for acute coronary syndrome with ST-segment elevation. Emergency Care Journal, 16(1). https://doi.org/10.4081/ecj.2020.8596