1
|
Freitas L, Amaral A, Conceição R, Barbosa G, Hamoy MK, Barbosa A, Paz C, Santos M, Hamoy A, Paz A, Favacho-Lopes D, Mello V, Hamoy M. Potentiation of the depressant effect of alcohol by flunitrazepam in rats: an electrocorticographic, respiratory and electrocardiographic study. NAUNYN-SCHMIEDEBERG'S ARCHIVES OF PHARMACOLOGY 2024:10.1007/s00210-024-03111-w. [PMID: 38676788 DOI: 10.1007/s00210-024-03111-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 04/18/2024] [Indexed: 04/29/2024]
Abstract
Alcohol, a widely commercialized psychotropic drug, and the benzodiazepine Flunitrazepam, an anxiolytic widely prescribed for patients with anxiety and insomnia problems, are well known drugs and both act on the central nervous system. The misuse and the association of these two drugs are public health concerns in several countries and could cause momentary, long-lasting and even lethal neurophysiological problems due to the potentiation of their adverse effects in synergy. The present study observed the result of the association of these drugs on electrophysiological responses in the brain, heart, and respiratory rate in Wistar rats. 8 experimental groups were determined: control, one alcohol group (20% at a dose of 1 ml/100 g VO), three Flunitrazepam groups (doses 0.1; 0.2 and 0.3 mg/kg) and three alcohol-Flunitrazepam groups (20% at a dose of 1 ml/100 g VO of alcohol, combined with 0.1; 0.2 and 0.3 mg/kg of Flunitrazepam, respectively). The results showed that there was a more pronounced reduction in alpha and theta wave power in the alcohol-Flunitrazepam groups, a decrease in the power of beta oscillations and greater sedation. There was a progressive decrease in respiratory rate linked to the increase of Flunitrazepam dose in the alcohol-Flunitrazepam associated administration. It was observed alteration in heart rate and Q-T interval in high doses of Flunitrazepam. Therefore, we conclude that the association alcohol-Flunitrazepam presented deepening of depressant synergistic effects according to the increase in the dose of the benzodiazepine, and this could cause alterations in low frequency brain oscillations, breathing, and hemodynamics of the patient.
Collapse
Affiliation(s)
- Luiz Freitas
- Laboratory of Pharmacology and Toxicology of Natural Products, Biological Science Institute, Federal University of Pará, Belém, Brazil.
| | - Anthony Amaral
- Laboratory of Pharmacology and Toxicology of Natural Products, Biological Science Institute, Federal University of Pará, Belém, Brazil
| | - Raína Conceição
- Laboratory of Pharmacology and Toxicology of Natural Products, Biological Science Institute, Federal University of Pará, Belém, Brazil
| | - Gabriela Barbosa
- Laboratory of Pharmacology and Toxicology of Natural Products, Biological Science Institute, Federal University of Pará, Belém, Brazil
| | - Maria Klara Hamoy
- Laboratory of Pharmacology and Toxicology of Natural Products, Biological Science Institute, Federal University of Pará, Belém, Brazil
| | - Anara Barbosa
- Laboratory of Pharmacology and Toxicology of Natural Products, Biological Science Institute, Federal University of Pará, Belém, Brazil
| | - Clarissa Paz
- Laboratory of Pharmacology and Toxicology of Natural Products, Biological Science Institute, Federal University of Pará, Belém, Brazil
| | - Murilo Santos
- Laboratory of Pharmacology and Toxicology of Natural Products, Biological Science Institute, Federal University of Pará, Belém, Brazil
| | - Akira Hamoy
- Laboratory of Pharmacology and Toxicology of Natural Products, Biological Science Institute, Federal University of Pará, Belém, Brazil
| | - Allane Paz
- Laboratory of Pharmacology and Toxicology of Natural Products, Biological Science Institute, Federal University of Pará, Belém, Brazil
| | - Dielly Favacho-Lopes
- Laboratory of Experimental Neuropathology, Biological Science Institute, Federal University of Pará, Belém, Brazil
| | - Vanessa Mello
- Laboratory of Pharmacology and Toxicology of Natural Products, Biological Science Institute, Federal University of Pará, Belém, Brazil
| | - Moisés Hamoy
- Laboratory of Pharmacology and Toxicology of Natural Products, Biological Science Institute, Federal University of Pará, Belém, Brazil
| |
Collapse
|
2
|
Ceasovschih A, Șorodoc V, Covantsev S, Balta A, Uzokov J, Kaiser SE, Almaghraby A, Lionte C, Stătescu C, Sascău RA, Onofrei V, Haliga RE, Stoica A, Bologa C, Ailoaei Ș, Şener YZ, Kounis NG, Șorodoc L. Electrocardiogram Features in Non-Cardiac Diseases: From Mechanisms to Practical Aspects. J Multidiscip Healthc 2024; 17:1695-1719. [PMID: 38659633 PMCID: PMC11041971 DOI: 10.2147/jmdh.s445549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 04/10/2024] [Indexed: 04/26/2024] Open
Abstract
Despite the noteworthy advancements and the introduction of new technologies in diagnostic tools for cardiovascular disorders, the electrocardiogram (ECG) remains a reliable, easily accessible, and affordable tool to use. In addition to its crucial role in cardiac emergencies, ECG can be considered a very useful ancillary tool for the diagnosis of many non-cardiac diseases as well. In this narrative review, we aimed to explore the potential contributions of ECG for the diagnosis of non-cardiac diseases such as stroke, migraine, pancreatitis, Kounis syndrome, hypothermia, esophageal disorders, pulmonary embolism, pulmonary diseases, electrolyte disturbances, anemia, coronavirus disease 2019, different intoxications and pregnancy.
Collapse
Affiliation(s)
- Alexandr Ceasovschih
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- 2nd Internal Medicine Department, “Sf. Spiridon” Clinical Emergency Hospital, Iasi, Romania
| | - Victorița Șorodoc
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- 2nd Internal Medicine Department, “Sf. Spiridon” Clinical Emergency Hospital, Iasi, Romania
| | - Serghei Covantsev
- Department of Research and Clinical Development, Botkin Hospital, Moscow, Russia
| | - Anastasia Balta
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- 2nd Internal Medicine Department, “Sf. Spiridon” Clinical Emergency Hospital, Iasi, Romania
| | - Jamol Uzokov
- Department of Cardiology, Republican Specialized Scientific Practical Medical Center of Therapy and Medical Rehabilitation, Tashkent, Uzbekistan
| | - Sergio E Kaiser
- Discipline of Clinical and Experimental Pathophysiology, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Abdallah Almaghraby
- Department of Cardiology, Ibrahim Bin Hamad Obaidallah Hospital, Ras Al Khaimah, United Arab Emirates
| | - Cătălina Lionte
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- 2nd Internal Medicine Department, “Sf. Spiridon” Clinical Emergency Hospital, Iasi, Romania
| | - Cristian Stătescu
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- Department of Cardiology, “Prof. Dr. George I.M. Georgescu” Cardiovascular Diseases Institute, Iasi, Romania
| | - Radu A Sascău
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- Department of Cardiology, “Prof. Dr. George I.M. Georgescu” Cardiovascular Diseases Institute, Iasi, Romania
| | - Viviana Onofrei
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- Department of Cardiology, “Sf. Spiridon” Clinical Emergency Hospital, Iasi, Romania
| | - Raluca Ecaterina Haliga
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- 2nd Internal Medicine Department, “Sf. Spiridon” Clinical Emergency Hospital, Iasi, Romania
| | - Alexandra Stoica
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- 2nd Internal Medicine Department, “Sf. Spiridon” Clinical Emergency Hospital, Iasi, Romania
| | - Cristina Bologa
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- 2nd Internal Medicine Department, “Sf. Spiridon” Clinical Emergency Hospital, Iasi, Romania
| | - Ștefan Ailoaei
- Department of Cardiology, “Prof. Dr. George I.M. Georgescu” Cardiovascular Diseases Institute, Iasi, Romania
| | - Yusuf Ziya Şener
- Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkiye
| | - Nicholas G Kounis
- Department of Internal Medicine, Division of Cardiology, University of Patras Medical School, Patras, Greece
| | - Laurențiu Șorodoc
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- 2nd Internal Medicine Department, “Sf. Spiridon” Clinical Emergency Hospital, Iasi, Romania
| |
Collapse
|
3
|
Ciuffo L, Tung M, Dukes JW, Vittinghoff E, Moss JD, Lee RJ, Lee BK, Tseng ZH, Vedantham V, Olgin JE, Scheinman MM, Hsia H, Ramchandani VA, Gerstenfeld EP, Marcus GM. Acute alcohol exposure and electrocardiographic changes: Finding from the HOLIDAY trial. J Electrocardiol 2024; 83:26-29. [PMID: 38295539 DOI: 10.1016/j.jelectrocard.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 12/30/2023] [Accepted: 01/12/2024] [Indexed: 02/02/2024]
Abstract
BACKGROUND Alcohol consumption is associated with a higher increased risk of atrial fibrillation (AF), but the acute effects on cardiac electrophysiology in humans remain poorly understood. The HOw ALcohol InDuces Atrial TachYarrhythmias (HOLIDAY) Trial revealed that alcohol shortened pulmonary vein atrial effective refractory periods, but more global electrophysiologic changes gleaned from the surface ECG have not yet been reported. METHODS This was a secondary analysis of the HOLIDAY Trial. During AF ablation procedures, 100 adults were randomized to intravenous alcohol titrated to 0.08% blood alcohol concentration versus a volume and osmolarity-matched, masked, placebo. Intervals measured from 12‑lead ECGs were compared between pre infusion and at infusion steady state (20 min). RESULTS The average age was 60 years and 11% were female. No significant differences in the P-wave duration, PR, QRS or QT intervals, were present between alcohol and placebo arms. However, infusion of alcohol was associated with a statistically significant relative shortening of the JT interval (r: -14.73, p = 0.048) after multivariable adjustment. CONCLUSION Acute exposure to alcohol was associated with a relative reduction in the JT interval, reflecting shortening of ventricular repolarization. These acute changes may reflect a more global shortening of refractoriness, suggesting immediate proarrhythmic effects pertinent to the atria and ventricles.
Collapse
Affiliation(s)
- Luisa Ciuffo
- Division of Cardiology, University of California San Francisco, San Francisco, CA, USA
| | - Monica Tung
- Division of Cardiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | | | - Eric Vittinghoff
- Department of Epidemiology and Biostatistics, University of California-San Francisco, San Francisco, CA, USA
| | - Joshua D Moss
- Division of Cardiology, University of California San Francisco, San Francisco, CA, USA
| | - Randall J Lee
- Division of Cardiology, University of California San Francisco, San Francisco, CA, USA
| | - Byron K Lee
- Division of Cardiology, University of California San Francisco, San Francisco, CA, USA
| | - Zian H Tseng
- Division of Cardiology, University of California San Francisco, San Francisco, CA, USA
| | - Vasanth Vedantham
- Division of Cardiology, University of California San Francisco, San Francisco, CA, USA
| | - Jeffrey E Olgin
- Division of Cardiology, University of California San Francisco, San Francisco, CA, USA
| | - Melvin M Scheinman
- Division of Cardiology, University of California San Francisco, San Francisco, CA, USA
| | - Henry Hsia
- Division of Cardiology, University of California San Francisco, San Francisco, CA, USA
| | | | - Edward P Gerstenfeld
- Division of Cardiology, University of California San Francisco, San Francisco, CA, USA
| | - Gregory M Marcus
- Division of Cardiology, University of California San Francisco, San Francisco, CA, USA.
| |
Collapse
|
4
|
Wong CX, Tu SJ, Marcus GM. Alcohol and Arrhythmias. JACC Clin Electrophysiol 2023; 9:266-279. [PMID: 36858701 DOI: 10.1016/j.jacep.2022.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 10/12/2022] [Indexed: 03/03/2023]
Abstract
The association between alcohol consumption and abnormalities of heart rate and rhythm has long been recognized. Significant attention has focused on the risk of atrial fibrillation (AF) and sudden cardiac death (SCD) with excessive alcohol intake. Recent studies have advanced our understanding of these relationships and provided additional insights into potentially arrhythmogenic mechanisms. However, considerable uncertainty remains, such as the level of consumption at which harm begins and whether alcohol plays a role in other arrhythmias. This review characterizes the spectrum of conduction abnormalities and heart rhythm disorders in relation to alcohol consumption. In addition, it discusses the latest epidemiologic and experimental evidence, the potential importance of beverage type and constituent ingredients, and conflicting information on drink definitions, thresholds, and recommendations.
Collapse
Affiliation(s)
- Christopher X Wong
- Department of Electrophysiology, Division of Cardiology, University of California-San Francisco, San Francisco, California, USA; Centre for Heart Rhythm Disorders (CHRD), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Samuel J Tu
- Centre for Heart Rhythm Disorders (CHRD), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Gregory M Marcus
- Department of Electrophysiology, Division of Cardiology, University of California-San Francisco, San Francisco, California, USA.
| |
Collapse
|
5
|
Ohlrogge AH, Frost L, Schnabel RB. Harmful Impact of Tobacco Smoking and Alcohol Consumption on the Atrial Myocardium. Cells 2022; 11:cells11162576. [PMID: 36010652 PMCID: PMC9406618 DOI: 10.3390/cells11162576] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 08/05/2022] [Accepted: 08/11/2022] [Indexed: 11/23/2022] Open
Abstract
Tobacco smoking and alcohol consumption are widespread exposures that are legal and socially accepted in many societies. Both have been widely recognized as important risk factors for diseases in all vital organ systems including cardiovascular diseases, and with clinical manifestations that are associated with atrial dysfunction, so-called atrial cardiomyopathy, especially atrial fibrillation and stroke. The pathogenesis of atrial cardiomyopathy, atrial fibrillation, and stroke in context with smoking and alcohol consumption is complex and multifactorial, involving pathophysiological mechanisms, environmental, and societal aspects. This narrative review summarizes the current literature regarding alterations in the atrial myocardium that is associated with smoking and alcohol.
Collapse
Affiliation(s)
- Amelie H. Ohlrogge
- Department of Cardiology, University Heart and Vascular Centre Hamburg, 20246 Hamburg, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, 20246 Hamburg, Germany
| | - Lars Frost
- Diagnostic Centre, University Clinic for Development of Innovative Patient Pathways, Silkeborg Regional Hospital, 8600 Silkeborg, Denmark
- Department of Clinical Medicine, Aarhus University, 8200 Aarhus, Denmark
| | - Renate B. Schnabel
- Department of Cardiology, University Heart and Vascular Centre Hamburg, 20246 Hamburg, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, 20246 Hamburg, Germany
- Correspondence:
| |
Collapse
|
6
|
de Veld L, van der Lely N, Hermans BJM, van Hoof JJ, Wong L, Vink AS. QTc prolongation in adolescents with acute alcohol intoxication. Eur J Pediatr 2022; 181:2757-2770. [PMID: 35482092 PMCID: PMC9192465 DOI: 10.1007/s00431-022-04471-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 03/30/2022] [Accepted: 04/09/2022] [Indexed: 01/24/2023]
Abstract
In adults, alcohol intoxication is associated with prolongation of the QT interval corrected for heart rate (QTc). The QTc is influenced by age and sex. Although alcohol intoxication is increasingly common in adolescents, there are no data on the prevalence of QTc prolongation in adolescents with alcohol intoxication. This study aimed to determine the prevalence of QTc prolongation in adolescents with alcohol intoxication and identify at-risk adolescents. In this observational study including adolescents aged 10-18 years, heart rate and QT interval were automatically assessed from an electrocardiogram (ECG) at alcohol intoxication using a validated algorithm. The QTc was calculated using both the Bazett formula (QTcB) and Fridericia formula (QTcF). If present, an ECG recorded within 1 year of the date of admission to the emergency department was obtained as a reference ECG. A total of 317 adolescents were included; 13.3% had a QTcB and 7.9% a QTcF longer than the sex- and age-specific 95th-percentile. None of the adolescents had a QTcB or QTcF > 500 ms, but 11.8% of the adolescents with a reference ECG had a QTcB prolongation of > 60 ms, while no adolescents had a QTcF prolongation of > 60 ms. QTc prolongation was mainly attributable to an increase in heart rate rather than QT prolongation, which underlies the differences between QTcB and QTcF. Male sex and hypokalaemia increased the likelihood of QTc prolongation.Conclusion: QTc prolongation was seen in approximately 10% of the adolescents presenting with alcohol intoxication, and although no ventricular arrhythmias were observed in this cohort, QTc prolongation increases the potential for malignant QT-related arrhythmias. Clinicians must be aware of the possibility of QTc prolongation during alcohol intoxication and make an effort to obtain an ECG at presentation, measure the QT interval, and give an adequate assessment of the findings. We advocate admitting adolescents with alcohol intoxication and QTc prolongation. During hospital admission, we recommend limiting exposure to QTc-prolonging medication, increasing potassium levels to a high-normal range (4.5-5.0 mmol/L) and obtaining a reference ECG at discharge.
Collapse
Affiliation(s)
- Loes de Veld
- Erasmus School of Health Policy and Management, Erasmus University, Postbus 1738, 3000, Rotterdam, DR, Netherlands. .,Department of Pediatrics, Reinier de Graaf Hospital, Delft, Netherlands.
| | - Nico van der Lely
- Department of Pediatrics, Reinier de Graaf Hospital, Delft, Netherlands ,Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Ben J. M. Hermans
- Department of Physiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, Netherlands
| | - Joris J. van Hoof
- Department of Pediatrics, Reinier de Graaf Hospital, Delft, Netherlands
| | - Lichelle Wong
- Department of Pediatrics, Reinier de Graaf Hospital, Delft, Netherlands
| | - Arja Suzanne Vink
- Department of Cardiology, Heart Center, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands ,Department of Pediatric Cardiology, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| |
Collapse
|
7
|
Brunner S, Winter R, Werzer C, von Stülpnagel L, Clasen I, Hameder A, Stöver A, Graw M, Bauer A, Sinner MF. Impact of acute ethanol intake on cardiac autonomic regulation. Sci Rep 2021; 11:13255. [PMID: 34168256 PMCID: PMC8225621 DOI: 10.1038/s41598-021-92767-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 06/01/2021] [Indexed: 12/21/2022] Open
Abstract
Acute alcohol consumption may facilitate cardiac arrhythmias underlying the ‘Holiday Heart Syndrome’. Autonomic imbalance is promoting atrial arrhythmias. We analyzed the effects of alcohol on measures of the cardiac autonomic nervous system and their relation to arrhythmias. In 15 healthy individuals, alcohol was administered parenterally until a breath alcohol concentration of 0.50 mg/l. High-resolution digital 30-min ECGs were recorded at baseline, at the time of maximum alcohol concentration, and after alcohol concentration returned to near baseline. Using customized software, we assessed periodic repolarization dynamics (PRD), deceleration capacity (DC), standard measures of heart rate variability (SDNN; RMSSD; LF; HF), and standard ECG parameters (mean heart rate; PQ; QRS; QTc interval). At the maximum alcohol concentration, PRD levels were significantly increased compared to baseline [1.92 (IQR 1.14–3.33) deg2 vs. 0.85 (0.69–1.48) deg2; p = 0.001]. PRD levels remained slightly increased when alcohol concentrations returned to baseline. DC levels were significantly decreased at the maximum alcohol concentration compared to baseline [7.79 (5.89–9.62) ms vs. 9.97 (8.20–10.99) ms; p = 0.030], and returned to baseline levels upon reaching baseline levels of alcohol. Standard HRV measures were reduced at maximum alcohol concentration. The mean heart rate increased significantly during alcohol administration. QRS and QTc duration were significantly prolonged, whereas PQ interval showed no change. Our findings revealed an increase of sympathetic activity and a reduction of parasympathetic activity under the influence of alcohol administration, resulting in autonomic imbalance. This imbalance might ultimately trigger arrhythmias underlying the ‘Holiday Heart Syndrome’.
Collapse
Affiliation(s)
- Stefan Brunner
- Department of Medicine I, University Hospital, Ludwig Maximilians University (LMU) Munich, Ziemssenstrasse 1, 80336, Munich, Germany.
| | - Raphaela Winter
- Department of Medicine I, University Hospital, Ludwig Maximilians University (LMU) Munich, Ziemssenstrasse 1, 80336, Munich, Germany
| | - Christina Werzer
- Department of Medicine I, University Hospital, Ludwig Maximilians University (LMU) Munich, Ziemssenstrasse 1, 80336, Munich, Germany
| | - Lukas von Stülpnagel
- Department of Medicine I, University Hospital, Ludwig Maximilians University (LMU) Munich, Ziemssenstrasse 1, 80336, Munich, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site: Munich Heart Alliance, Munich, Germany.,Department of Internal Medicine III, Medical University Innsbruck, Innsbruck, Austria
| | - Ina Clasen
- Institute of Legal Medicine, LMU Munich, Munich, Germany
| | - Annika Hameder
- Institute of Legal Medicine, LMU Munich, Munich, Germany
| | - Andreas Stöver
- Institute of Legal Medicine, LMU Munich, Munich, Germany
| | - Matthias Graw
- Institute of Legal Medicine, LMU Munich, Munich, Germany
| | - Axel Bauer
- German Center for Cardiovascular Research (DZHK), Partner Site: Munich Heart Alliance, Munich, Germany.,Department of Internal Medicine III, Medical University Innsbruck, Innsbruck, Austria
| | - Moritz F Sinner
- Department of Medicine I, University Hospital, Ludwig Maximilians University (LMU) Munich, Ziemssenstrasse 1, 80336, Munich, Germany. .,German Center for Cardiovascular Research (DZHK), Partner Site: Munich Heart Alliance, Munich, Germany.
| |
Collapse
|
8
|
Effects of acute alcohol consumption on cardiac excitation, conduction, and repolarization: results from the Munich Beer Related Electrocardiogram Workup Study (MunichBREW). Clin Res Cardiol 2021; 110:916-918. [PMID: 33738543 PMCID: PMC8166672 DOI: 10.1007/s00392-021-01839-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 03/05/2021] [Indexed: 11/25/2022]
|
9
|
Second-degree atrioventricular block in an adolescent with an acute alcohol intoxication. Am J Emerg Med 2020; 38:407.e1-407.e3. [DOI: 10.1016/j.ajem.2019.158419] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 08/24/2019] [Accepted: 08/28/2019] [Indexed: 11/23/2022] Open
|
10
|
Podgurskaya AD, Tsvelaya VA, Frolova SR, Kalita IY, Kudryashova NN, Agladze KI. Effect of heptanol and ethanol on excitation wave propagation in a neonatal rat ventricular myocyte monolayer. Toxicol In Vitro 2018; 51:136-144. [PMID: 29778719 DOI: 10.1016/j.tiv.2018.05.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Revised: 05/11/2018] [Accepted: 05/15/2018] [Indexed: 11/24/2022]
Abstract
In this work, the action of heptanol and ethanol was investigated in a two-dimensional (2D) model of cardiac tissue: the neonatal rat ventricular myocyte monolayer. Heptanol is known in electrophysiology as a gap junction uncoupler but may also inhibit voltage-gated ionic channels. Ethanol is often associated with the occurrence of arrhythmias. These substances influence sodium, calcium, and potassium channels, but the complete mechanism of action of heptanol and ethanol remains unknown. The optical mapping method was used to measure conduction velocities (CVs) in concentrations of 0.05-1.8 mM heptanol and 17-1342 mM ethanol. Heptanol was shown to slow the excitation wave significantly, and a mechanism that involves a simultaneous action on cell coupling and activation threshold was suggested. Whole-cell patch-clamp experiments showed inhibition of sodium and calcium currents at a concentration of 0.5 mM heptanol. Computer modeling was used to estimate the relative contribution of the cell uncoupling and activation threshold increase caused by heptanol. Unlike heptanol, ethanol slightly influenced the CV at clinically relevant concentrations. Additionally, the critical concentrations for re-entry formation in ethanol were determined.
Collapse
Affiliation(s)
- A D Podgurskaya
- The Laboratory of the Biophysics of Excitable Systems, Moscow Institute of Physics and Technology (State University), 9 Institutskiy per., Dolgoprudny, Moscow Region 141701, Russian Federation
| | - V A Tsvelaya
- The Laboratory of the Biophysics of Excitable Systems, Moscow Institute of Physics and Technology (State University), 9 Institutskiy per., Dolgoprudny, Moscow Region 141701, Russian Federation
| | - S R Frolova
- The Laboratory of the Biophysics of Excitable Systems, Moscow Institute of Physics and Technology (State University), 9 Institutskiy per., Dolgoprudny, Moscow Region 141701, Russian Federation
| | - I Y Kalita
- The Laboratory of the Biophysics of Excitable Systems, Moscow Institute of Physics and Technology (State University), 9 Institutskiy per., Dolgoprudny, Moscow Region 141701, Russian Federation
| | - N N Kudryashova
- The Laboratory of the Biophysics of Excitable Systems, Moscow Institute of Physics and Technology (State University), 9 Institutskiy per., Dolgoprudny, Moscow Region 141701, Russian Federation; Department of Physics and Astronomy, Ghent University, B-9000 Ghent, Belgium
| | - K I Agladze
- The Laboratory of the Biophysics of Excitable Systems, Moscow Institute of Physics and Technology (State University), 9 Institutskiy per., Dolgoprudny, Moscow Region 141701, Russian Federation.
| |
Collapse
|
11
|
Raheja H, Namana V, Chopra K, Sinha A, Gupta SS, Kamholz S, Moskovits N, Shani J, Hollander G. Electrocardiogram Changes with Acute Alcohol Intoxication: A Systematic Review. Open Cardiovasc Med J 2018. [PMID: 29541259 PMCID: PMC5838641 DOI: 10.2174/1874192401812010001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background: Acute alcohol intoxication has been associated with cardiac arrhythmias but the electrocardiogram (ECG) changes associated with acute alcohol intoxication are not well defined in the literature. Objective: Highlight the best evidence regarding the ECG changes associated with acute alcohol intoxication in otherwise healthy patients and the pathophysiology of the changes. Methods: A literature search was carried out; 4 studies relating to ECG changes with acute alcohol intoxication were included in this review. Results: Of the total 141 patients included in the review, 90 (63.8%) patients had P-wave prolongation, 80 (56%) patients had QTc prolongation, 19 (13.5%) patients developed T-wave abnormalities, 10 (7%) patients had QRS complex prolongation, 3 (2.12%) patients developed ST-segment depressions. Conclusion: The most common ECG changes associated with acute alcohol intoxication are (in decreasing order of frequency) P-wave and QTc prolongation, followed by T-wave abnormalities and QRS complex prolongation. Mostly, these changes are completely reversible.
Collapse
Affiliation(s)
| | | | - Kirti Chopra
- Indiana University School of Dentistry, Indianapolis, USA
| | | | | | | | | | | | | |
Collapse
|
12
|
Assessment of Cardiovascular Function and Microvascular Permeability in a Conscious Rat Model of Alcohol Intoxication Combined with Hemorrhagic Shock and Resuscitation. Methods Mol Biol 2018; 1717:61-81. [PMID: 29468584 DOI: 10.1007/978-1-4939-7526-6_6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Hypotension, cardiac depression, and elevated microvascular permeability are known problems that complicate resuscitation of patients following traumatic injury, particularly those who are also intoxicated from alcohol consumption. A conscious rat model of combined alcohol intoxication and hemorrhagic shock has been used to study the hemodynamic mechanisms involved. Here, we describe using this model to study microvascular leakage and cardiac electrical activity.
Collapse
|
13
|
Bébarová M, Horáková Z, Kula R. Addictive drugs, arrhythmias, and cardiac inward rectifiers. Europace 2017; 19:346-355. [PMID: 27302393 DOI: 10.1093/europace/euw071] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 02/20/2016] [Indexed: 12/30/2022] Open
Abstract
In many addictive drugs including alcohol and nicotine, proarrhythmic effects were reported. This review provides an overview of the current knowledge in this field (with a focus on the inward rectifier potassium currents) to promote the lacking data and appeal for their completion, thus, to improve understanding of the proarrhythmic potential of addictive drugs.
Collapse
|
14
|
Chu T, Azevedo K, Ernst AA, Sarangarm D, Weiss SJ. A Comparison of QTc Intervals in Alcohol Withdrawal Patients Versus Acute Coronary Syndrome Patients. South Med J 2017; 110:475-479. [PMID: 28679017 DOI: 10.14423/smj.0000000000000674] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Patients with an alcohol use disorder experiencing acute intoxication or withdrawal may be at risk for electrocardiograph (ECG) abnormalities, including prolongation of repolarization (long QTc [corrected QT]) that may contribute to arrhythmias and may be associated with a threefold increase in the likelihood of sudden cardiac events. Patients with acute coronary syndrome may have prolonged QTc as well. To our knowledge, no previous studies have compared the QTc of ACS with acute ethanol (EtOH) withdrawal syndromes in the emergency department (ED). The purpose of our study was to compare the QTc of those with EtOH withdrawal emergencies with patients with ACS in our ED. Our hypothesis was that the QTc would be similarly prolonged in the two cohorts. METHODS The study compared two cohort groups, those with ACS and those with EtOH withdrawal-related ED visits over a 1-year period. We compared ECG QTc, cardiac medication use, and electrolyte differences. We considered a QTc of >450 ms elevated for men and >470 ms elevated for women based on the literature. Fifty subjects in whom an ECG, serum osmolality, and EtOH level were recorded within 2 hours of one another and who were administered a Clinical Institute Withdrawal Assessment protocol were compared with 203 patients with ACS during the same period. We excluded patients with incomplete data. Medications compared included clopidogrel, acetylsalicylic acid, β-blockers, angiotensin-converting enzyme inhibitors, and statins. ECG QT and QTc, as well as electrolytes, were recorded and compared. Data were extracted by two investigators with a 20% sample re-evaluated by the other extractor as a reliability measure. Descriptive statistics including medians and interquartile ranges were measured for continuous variables. Comparisons were made using two-tailed t tests for parametric data and the Mann-Whitney U test for nonparametric data. RESULTS Agreement in the 20% sampling between investigators was high (96%). The mean QTc in the ACS group was 457 ms and the mean QTc in the EtOH withdrawal-related group was 468 ms (diff 11, not significant). Significantly more patients had a prolonged QTc in the EtOH withdrawal group than in the ACS group 62% vs 46%; diff 16; 95% CI (0.1, 30). There was significantly more use of clopidogrel, acetylsalicylic acid, angiotensin-converting enzyme inhibitors, and statins (P < 0.05 for all) in the ACS group compared with the EtOH withdrawal group; however, there was no difference in β-blocker usage. There was a significantly higher admission rate: 100% of ACS compared with 76% of the EtOH withdrawal group (P < 0.01, diff 24, 95% confidence interval 18-29). Electrolytes were not significantly different in the two groups. CONCLUSIONS More patients with EtOH withdrawal-related ED visits had a long QTc than patients presenting with ACS. ED physicians should carefully monitor patients experiencing EtOH withdrawal for cardiac arrhythmias and obtain an ECG. If any medications that prolong the QTc are considered, then an ECG should be obtained before administering medications that may affect the myocardium to make medication safer for the patient.
Collapse
Affiliation(s)
- Timothy Chu
- From the Department of Emergency Medicine, University of New Mexico, Albuquerque
| | - Keith Azevedo
- From the Department of Emergency Medicine, University of New Mexico, Albuquerque
| | - Amy A Ernst
- From the Department of Emergency Medicine, University of New Mexico, Albuquerque
| | - Dusadee Sarangarm
- From the Department of Emergency Medicine, University of New Mexico, Albuquerque
| | - Steven J Weiss
- From the Department of Emergency Medicine, University of New Mexico, Albuquerque
| |
Collapse
|
15
|
BÉBAROVÁ M, MATEJOVIČ P, ŠIMURDOVÁ M, ŠIMURDA J. Acetaldehyde at Clinically Relevant Concentrations Inhibits Inward Rectifier Potassium Current IK1 in Rat Ventricular Myocytes. Physiol Res 2015; 64:939-43. [DOI: 10.33549/physiolres.932985] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Considering the effects of alcohol on cardiac electrical behavior as well as the important role of the inward rectifier potassium current IK1 in arrhythmogenesis, this study was aimed at the effect of acetaldehyde, the primary metabolite of ethanol, on IK1 in rat ventricular myocytes. Acetaldehyde induced a reversible inhibition of IK1 with IC50 = 53.7±7.7 µM at –110 mV; a significant inhibition was documented even at clinically-relevant concentrations (at 3 µM by 13.1±3.0 %). The inhibition was voltage-independent at physiological voltages above –90 mV. The IK1 changes under acetaldehyde may contribute to alcohol-induced alterations of cardiac electrophysiology, especially in individuals with a genetic defect of aldehyde dehydrogenase where the acetaldehyde level may be elevated.
Collapse
Affiliation(s)
- M. BÉBAROVÁ
- Department of Physiology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | | | | | | |
Collapse
|
16
|
Arbour L, Asuri S, Whittome B, Polanco F, Hegele RA. The Genetics of Cardiovascular Disease in Canadian and International Aboriginal Populations. Can J Cardiol 2015; 31:1094-115. [DOI: 10.1016/j.cjca.2015.07.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 07/08/2015] [Accepted: 07/09/2015] [Indexed: 12/16/2022] Open
|
17
|
Acute effects of ethanol on action potential and intracellular Ca(2+) transient in cardiac ventricular cells: a simulation study. Med Biol Eng Comput 2015; 54:753-62. [PMID: 26280513 DOI: 10.1007/s11517-015-1366-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 08/03/2015] [Indexed: 01/08/2023]
Abstract
Alcohol consumption may result in electrocardiographic changes and arrhythmias, at least partly due to effects of ethanol on cardiac ionic currents. Contractility and intracellular Ca(2+) dynamics seem to be altered as well. In this study, we integrated the available (mostly animal) experimental data into previously published models of the rat and human ventricular myocytes to assess the share of ionic current components in ethanol-induced changes in AP configuration and cytosolic Ca(2+) transient in ventricular cardiomyocytes. The rat model reproduced well the experimentally observed changes in AP duration (APD) under ethanol (slight prolongation at 0.8 mM and shortening at ≥8 mM). These changes were almost exclusively caused by the ethanol-induced alterations of I K1. The cytosolic Ca(2+) transient decreased gradually with the increasing ethanol concentration as a result of the ethanol-induced inhibition of I Ca. In the human model, ethanol produced a dose-dependent APD lengthening, dominated by ethanol effect on I Kr, the key repolarising current in human ventricles. This effect might contribute to the clinically observed proarrhythmic effects of ethanol in predisposed individuals.
Collapse
|
18
|
Schenberg EE, de Castro Comis MA, Chaves BR, da Silveira DX. Treating drug dependence with the aid of ibogaine: a retrospective study. J Psychopharmacol 2014; 28:993-1000. [PMID: 25271214 DOI: 10.1177/0269881114552713] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Ibogaine is an alkaloid purported to be an effective drug dependence treatment. However, its efficacy has been hard to evaluate, partly because it is illegal in some countries. In such places, treatments are conducted in underground settings where fatalities have occurred. In Brazil ibogaine is unregulated and a combined approach of psychotherapy and ibogaine is being practiced to treat addiction. To evaluate the safety and efficacy of ibogaine, we conducted a retrospective analysis of data from 75 previous alcohol, cannabis, cocaine and crack users (72% poly-drug users). We observed no serious adverse reactions or fatalities, and found 61% of participants abstinent. Participants treated with ibogaine only once reported abstinence for a median of 5.5 months and those treated multiple times for a median of 8.4 months. This increase was statistically significant (p < 0.001), and both single or multiple treatments led to longer abstinence periods than before the first ibogaine session (p < 0.001). These results suggest that the use of ibogaine supervised by a physician and accompanied by psychotherapy can facilitate prolonged periods of abstinence, without the occurrence of fatalities or complications. These results suggest that ibogaine can be a safe and effective treatment for dependence on stimulant and other non-opiate drugs.
Collapse
Affiliation(s)
- Eduardo Ekman Schenberg
- Universidade Federal de São Paulo, Departamento de Psiquiatria, Instituto Plantando Consciência, São Paulo, Brazil
| | | | | | - Dartiu Xavier da Silveira
- Universidade Federal de São Paulo, Programa de Orientação e Atendimento a Dependentes (PROAD), Departamento de Psiquiatria, Instituto Plantando Consciência, São Paulo, Brazil
| |
Collapse
|
19
|
Abstract
Alcohol intoxication plays a significant and causal role in various fatal injuries. In comparison to sober individuals, intoxicated people have a greater generic risk for being involved in hazardous activities that may result in fatal injuries. However, it is not clear whether the biological effects of acute alcohol intoxication result in worse injuries than those sustained by sober individuals who are injured by identical mechanisms. Alcohol intoxication has a neuroprotective effect in experimental animal models of traumatic brain injury (TBI) but the evidence for a similar effect in humans is controversial. Earlier studies found such a protective effect, but more recent large epidemiological studies have not confirmed this finding; some studies also suggest a dose-related protective or exacerbating effect of alcohol intoxication on TBI. There are two apparent alcohol-associated syndromes in which an otherwise survivable blunt force impact to the head of an intoxicated individual is fatal at the scene. The first is a fatal cardiorespiratory arrest (the so-called alcohol concussion syndrome or “commotio medullaris”); the second is “traumatic basilar subarachnoid hemorrhage” (secondary to tears in the cerebral arteries, particularly the intracranial and extracranial vertebral arteries).
Collapse
Affiliation(s)
- David A. Ramsay
- London Health Sciences Centre in Ontario, South-Western Ontario and Ontario Provincial Forensic Pathology Units, and Western University in London, ON
| |
Collapse
|
20
|
Abstract
The impacts of chronic high levels of ethanol consumption on cardiovascular structure and function are reviewed as they pertain to forensic pathology practice. Both hypertrophy and remodeling of the myocardium as well as physiological revision of electrical conduction through the heart can occur in a progressive fashion. A discussion about the likely underappreciated spectrum of structural heart disease that may be seen in individuals with chronic alcohol dependence is presented. Finally, brief reference to the collision between alcohol, cardiovascular disease, and forensically relevant scenarios is provided.
Collapse
Affiliation(s)
- Kristopher S. Cunningham
- Forensic and Cardiovascular Pathologist with the Ontario Forensic Pathology Service, and Department of Pathology and Molecular Medicine, Queen's University, Kingston, ON
| |
Collapse
|
21
|
Tsai TF, Browning AC, Rutledge J. Global T-wave inversions with isolated hypomagnesemia. J Emerg Med 2013; 45:e107-e111. [PMID: 23896055 DOI: 10.1016/j.jemermed.2013.04.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Revised: 03/21/2013] [Accepted: 04/30/2013] [Indexed: 06/02/2023]
Abstract
BACKGROUND The physiological actions of magnesium within the cardiac conduction system and myocytes have yet to be fully elucidated. Because concurrent hypocalcemia or hypokalemia were also present in previous human reports, specific electrocardiographic effects of isolated hypomagnesemia have not been clearly delineated. OBJECTIVE We report a case in which dynamic electrocardiogram (ECG) changes were demonstrated in isolated hypomagnesemia. CASE REPORT A 37-year-old man with history of heavy alcohol use was admitted for syncope. The ECG showed global T-wave inversions with prolonged corrected QT (QTc) duration on ECG. Extensive work-up including cardiac catheterization was unremarkable. His serum magnesium was noted to be low at 1.1 mg/dL, and his serum calcium and potassium were within normal limits. The patient received magnesium infusion with subsequent ECGs showing resolution of his global T-wave inversions and prolonged QTc. CONCLUSION This case is unique because it reports dynamic ECG changes in a patient with isolated hypomagnesemia. Although isolated hypomagnesemia is commonly believed to result in dysrhythmia, we were unaware of any previous cases of ECG abnormalities in humans. Clinically, we advise checking serum magnesium and correcting hypomagnesemia when prolonged QTc duration and global T-wave inversions are seen on ECG.
Collapse
Affiliation(s)
- Ting F Tsai
- Department of Cardiovascular Medicine, University of California-Davis Medical Center, Sacramento, California
| | | | | |
Collapse
|
22
|
Papadodima SA, Dona A, Evaggelakos CI, Goutas N, Athanaselis SA. Ibogaine related sudden death: a case report. J Forensic Leg Med 2013; 20:809-11. [PMID: 24112325 DOI: 10.1016/j.jflm.2013.06.032] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Revised: 06/28/2013] [Accepted: 06/29/2013] [Indexed: 01/30/2023]
Abstract
Ibogaine is a naturally occurring alkaloid derived from the roots of the rain forest shrub Tabernanthe iboga. Deaths have occurred temporarily related to the use of ibogaine. However, although not licensed as therapeutic drug, and despite evidence that ibogaine may disturb the rhythm of the heart, this alkaloid is currently used as an anti-addiction drug in alternative medicine for detoxification purposes. We report the case of a man who died suddenly 12-24 h after ibogaine use for alcohol detoxification treatment. In the autopsy liver cirrhosis and heavy fatty infiltration was found. The concentration of ibogaine was 2 mg/l. The potential risks of ibogaine use, especially for persons with pathological medical background, are discussed.
Collapse
Affiliation(s)
- Stavroula A Papadodima
- Department of Forensic Medicine and Toxicology, School of Medicine, University of Athens, M. Asias 75, Goudi, Athens 115 27, Greece.
| | | | | | | | | |
Collapse
|
23
|
Li S, Korkmaz S, Loganathan S, Weymann A, Radovits T, Barnucz E, Hirschberg K, Hegedüs P, Zhou Y, Tao L, Páli S, Veres G, Karck M, Szabó G. Acute ethanol exposure increases the susceptibility of the donor hearts to ischemia/reperfusion injury after transplantation in rats. PLoS One 2012; 7:e49237. [PMID: 23155471 PMCID: PMC3498334 DOI: 10.1371/journal.pone.0049237] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2012] [Accepted: 10/07/2012] [Indexed: 11/30/2022] Open
Abstract
Background Many donor organs come from youths involved in alcohol-related accidental death. The use of cardiac allografts for transplantation from donors after acute poisoning is still under discussion while acute ethanol intoxication is associated with myocardial functional and morphological changes. The aims of this work were 1) to evaluate in rats the time-course cardiac effects of acute ethanol-exposure and 2) to explore how its abuse by donors might affect recipients in cardiac pump function after transplantation. Methods Rats received saline or ethanol (3.45 g/kg, ip). We evaluated both the mechanical and electrical aspects of cardiac function 1 h, 6 h or 24 h after injection. Plasma cardiac troponin-T and glucose-levels were measured and histological examination of the myocardium was performed. In addition, heart transplantation was performed, in which donors received ethanol 6 h or 24 h prior to explantation. Graft function was measured 1 h or 24 h after transplantation. Myocardial TBARS-concentration was measured; mRNA and protein expression was assessed by quantitative real-time PCR and Western blot, respectively. Results Ethanol administration resulted in decreased load-dependent (−34±9%) and load-independent (−33±12%) contractility parameters, LV end-diastolic pressure and elevated blood glucose levels at 1 h, which were reversed to the level of controls after 6 h and 24 h. In contrast to systolic dysfunction, active relaxation and passive stiffness are slowly recovered or sustained during 24 h. Moreover, troponin-T-levels were increased at 1 h, 6 h and 24 h after ethanol injection. ST-segment elevation (+47±10%), elongated QT-interval (+38±4%), enlarged cardiomyocyte, DNA-strand breaks, increased both mRNA and protein levels of superoxide dismutase-1, glutathione peroxydase-4, cytochrome-c-oxidase and metalloproteinase-9 were observed 24 h following ethanol-exposure. After heart transplantation, decreased myocardial contractility and relaxation, oxidative stress and altered protein expression were observed. Conclusions These results demonstrate acute alcohol abuse increases the susceptibility of donor hearts to ischemia/reperfusion in a rat heart transplant model even though the global contractile function recovers 6 h after ethanol-administration.
Collapse
Affiliation(s)
- Shiliang Li
- Department of Cardiac Surgery, University of Heidelberg, Heidelberg, Germany
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Sevil Korkmaz
- Department of Cardiac Surgery, University of Heidelberg, Heidelberg, Germany
- * E-mail:
| | | | - Alexander Weymann
- Department of Cardiac Surgery, University of Heidelberg, Heidelberg, Germany
| | | | - Enikő Barnucz
- Department of Cardiac Surgery, University of Heidelberg, Heidelberg, Germany
- Heart Center, Semmelweis University, Budapest, Hungary
| | - Kristóf Hirschberg
- Department of Cardiac Surgery, University of Heidelberg, Heidelberg, Germany
| | - Peter Hegedüs
- Department of Cardiac Surgery, University of Heidelberg, Heidelberg, Germany
- Heart Center, Semmelweis University, Budapest, Hungary
| | - Yan Zhou
- Department of Otolaryngology, Union Hospital of Tongji Medical College, Hua-Zhong University of Science and Technology, Wuhan, China
| | - Liang Tao
- Department of Cardiac Surgery, Wuhan Asia Heart Hospital, Wuhan, China
| | - Szabolcs Páli
- Department of Cardiac Surgery, University of Heidelberg, Heidelberg, Germany
- Heart Center, Semmelweis University, Budapest, Hungary
| | - Gábor Veres
- Department of Cardiac Surgery, University of Heidelberg, Heidelberg, Germany
- Department of Cardiac Surgery, Semmelweis University, Budapest, Hungary
| | - Matthias Karck
- Department of Cardiac Surgery, University of Heidelberg, Heidelberg, Germany
| | - Gábor Szabó
- Department of Cardiac Surgery, University of Heidelberg, Heidelberg, Germany
| |
Collapse
|
24
|
Verelst S, Moonen PJ, Desruelles D, Gillet JB. Emergency department visits due to alcohol intoxication: characteristics of patients and impact on the emergency room. Alcohol Alcohol 2012; 47:433-8. [PMID: 22493048 DOI: 10.1093/alcalc/ags035] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
AIMS The aim of the study was to describe the epidemiology, management and cost of emergency department (ED) visits due to alcohol intoxication. METHODS A retrospective review of medical records of all episodes of alcohol intoxication was made, excepting those where another diagnosis such as trauma or psychiatric illness was primary, in patients older than 16 years, who presented to the ED of a large university hospital in Belgium over a 12-month period from 1 January 2009. RESULTS A total of 635 such patients accounted for 1.2% of all ED visits; 429 were males and 48.3% were aged between 41 and 60 years; 63.8% of the patients had a history of alcohol use disorder and 60.3% had a history of psychiatric disorder; 74.3% of the patients received some form of medical treatment and 62% were seen by a psychiatrist. Of the total, 57.5% of the patients were admitted to the ED observation ward, with a mean length of stay of 8.4 h. The estimated total cost was €318 838.25, with an average of €541.32 per patient. CONCLUSION Alcohol intoxication leads to a financial burden on the community. In addition to imposing physical, social and psychological stress on the community, the often agitated or aggressive patient imposes stress on ED staff. Close surveillance of trends in alcohol abuse is warranted, and the ED should consider implementing a questionnaire method of screening for alcohol abuse.
Collapse
Affiliation(s)
- Sandra Verelst
- Emergency Department, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium.
| | | | | | | |
Collapse
|
25
|
Alper KR, Stajić M, Gill JR. Fatalities temporally associated with the ingestion of ibogaine. J Forensic Sci 2012; 57:398-412. [PMID: 22268458 DOI: 10.1111/j.1556-4029.2011.02008.x] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Ibogaine is a naturally occurring psychoactive plant alkaloid that is used globally in medical and nonmedical settings for opioid detoxification and other substance use indications. All available autopsy, toxicological, and investigative reports were systematically reviewed for the consecutive series of all known fatalities outside of West Central Africa temporally related to the use of ibogaine from 1990 through 2008. Nineteen individuals (15 men, four women between 24 and 54 years old) are known to have died within 1.5-76 h of taking ibogaine. The clinical and postmortem evidence did not suggest a characteristic syndrome of neurotoxicity. Advanced preexisting medical comorbidities, which were mainly cardiovascular, and/or one or more commonly abused substances explained or contributed to the death in 12 of the 14 cases for which adequate postmortem data were available. Other apparent risk factors include seizures associated with withdrawal from alcohol and benzodiazepines and the uninformed use of ethnopharmacological forms of ibogaine.
Collapse
Affiliation(s)
- Kenneth R Alper
- Department of Psychiatry, New York University School of Medicine, New York, NY 10016, USA.
| | | | | |
Collapse
|
26
|
van Cleef ANH, Schuurman MJ, Busari JO. Third-degree atrioventricular block in an adolescent following acute alcohol intoxication. BMJ Case Rep 2011; 2011:bcr.07.2011.4547. [PMID: 22679160 DOI: 10.1136/bcr.07.2011.4547] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Alcohol abuse is a major problem among adolescents, and has both acute, potentially lethal, and long-term harmful effects. The authors describe an adolescent who was in a subcomatose condition after binge drinking. His serum alcohol concentration was 3.7 g/l. The next morning, before transfer to the paediatric ward, he developed a third-degree atrioventricular (AV) block without cardiac output while his infusion needle was removed. This recovered spontaneously after a precordial thump. Retrospectively, electrocardiography showed an increasing PR prolongation (200-300 ms) before the removal of the infusion needle. ECG recordings several hours later showed a first-degree AV block, which was no longer seen during follow-up, 1 month later. The authors conclude that acute alcohol poisoning has the potential to prolong the PR interval in young, healthy adolescents without pre-existing first-degree AV block and provoke a third-degree AV block after vagal stimulation. It is yet another potential danger of acute alcohol intoxication in this age group.
Collapse
Affiliation(s)
- Anne N H van Cleef
- Department of Pediatrics, Atrium Medical Centre, Heerlen, The Netherlands
| | | | | |
Collapse
|
27
|
Bébarová M, Matejovič P, Pásek M, Ohlídalová D, Jansová D, Simurdová M, Simurda J. Effect of ethanol on action potential and ionic membrane currents in rat ventricular myocytes. Acta Physiol (Oxf) 2010; 200:301-14. [PMID: 20618172 DOI: 10.1111/j.1748-1716.2010.02162.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM Even though alcohol intoxication is often linked to arrhythmias, data describing ethanol effect on cardiac ionic channels are rare. In addition, ethanol is used as a solvent of hydrophobic compounds in experimental studies. We investigated changes of the action potential (AP) configuration and main ionic membrane currents in rat cardiomyocytes under 20-1500 m(M) ethanol. METHODS Experiments were performed on enzymatically isolated rat right ventricular myocytes using the whole cell patch-clamp technique at room temperature. RESULTS Ethanol reversibly decelerated the upstroke velocity and decreased AP amplitude and duration at 0.2 and 3 Hz. The fast sodium current I(Na) , l-type calcium current I(Ca) and transient outward potassium current I(to) were reversibly inhibited in a concentration-dependent manner (50% inhibition at 446 ± 12, 553 ± 49 and 1954 ± 234 m(M), respectively, with corresponding Hill coefficients 3.1 ± 0.3, 1.1 ± 0.2 and 0.9 ± 0.1). Suppression of I(Na) and I(Ca) magnitude was slightly voltage dependent. The effect on I(Ca) and I(to) was manifested mainly as an acceleration of their apparent inactivations with a decreased slow and fast time constant respectively. As a consequence of marked differences in n(H) , sensitivity of the currents to ethanol at 10% inhibition decreases in the following order: I(Ca) (75 mm, 3.5‰), I(to) (170 m(M), 7.8‰) and I(Na) (220 m(M), 10.1‰). CONCLUSION Our results suggest a slight inhibition of all the currents at ethanol concentrations relevant to deep alcohol intoxication. The concentration dependence measured over a wide range may serve as a guideline when using ethanol as a solvent.
Collapse
Affiliation(s)
- M Bébarová
- Department of Physiology, Masaryk University, Brno - Bohunice, Czech Republic.
| | | | | | | | | | | | | |
Collapse
|
28
|
Alcohol exposure and outcomes in trauma patients. Eur J Trauma Emerg Surg 2010; 37:169-75. [PMID: 21837258 PMCID: PMC3150794 DOI: 10.1007/s00068-010-0038-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2010] [Accepted: 06/13/2010] [Indexed: 11/10/2022]
Abstract
Objective To determine the injury patterns, complications, and mortality after alcohol consumption in trauma patients. Methods The Trauma Registry at an American College of Surgeons (ACS) level I center was queried for all patients with a toxicology screen admitted between 1st January 2002 and 31st December 2005. Alcohol-positive (AP) patients were matched to control patients who had a completely negative screen (AN) using age, gender, mechanism, Injury Severity Score (ISS), head Abbreviated Injury Scale (AIS), chest AIS, abdominal AIS, and extremity AIS. Injuries and outcomes were compared between the groups. Results As many as 5,317 patients had toxicology data, of which 471 (8.9%) had a positive alcohol screen (AP). A total of 386 AP patients were then matched to 386 control (AN) patients. The AP group had a significantly higher mortality than the AN group overall (23 vs. 13%; p < 0.001), and by ISS stratification: ISS < 16 (6 vs. 0.4%; p < 0.001), ISS 16–25 (53 vs. 28%; p = 0.01), and ISS > 25 (90 vs. 67%; p = 0.01). AP patients had a higher incidence of admission systolic blood pressure < 90 (18 vs. 10%; p < 0.001) and Glasgow Coma Scale (GCS) score ≤ 8 (25 vs. 17%; p = 0.002). AN patients had a significantly higher incidence of hemopneumothorax (11 vs. 7%; p = 0.03), while AP patients had a higher incidence of cardiac arrest (8 vs. 3%; p = 0.004). There was no difference in intensive care unit (ICU) and hospital length of stay. Conclusion In a mixed population of trauma patients, an AP screen is associated with an increased incidence of admission hypotension and depressed GCS score. In this case-matched study, alcohol exposure appeared to increase mortality after injury.
Collapse
|
29
|
Miscellaneous drugs, materials, medical devices, and techniques. ACTA ACUST UNITED AC 2010. [DOI: 10.1016/s0378-6080(10)32049-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
|
30
|
Cameli M, Ballo P, Garzia A, Lisi M, Palmerini E, Spinelli T, Bocelli A, Mondillo S. Acute Effects of Low Doses of Red Wine on Cardiac Conduction and Repolarization in Young Healthy Subjects. Alcohol Clin Exp Res 2009; 33:2141-6. [DOI: 10.1111/j.1530-0277.2009.01054.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
31
|
Aasebø W. ECG-voltage in alcoholics and non-alcoholics with acute alcohol intoxication. J Forensic Leg Med 2009; 16:381-4. [DOI: 10.1016/j.jflm.2009.01.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2008] [Revised: 08/26/2008] [Accepted: 01/15/2009] [Indexed: 10/21/2022]
|
32
|
High-degree atrioventricular block in acute ethanol poisoning: a case report. CASES JOURNAL 2009; 2:8559. [PMID: 19918387 PMCID: PMC2769457 DOI: 10.4076/1757-1626-2-8559] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2009] [Accepted: 08/08/2009] [Indexed: 11/26/2022]
Abstract
Introduction Acute ethanol ingestion can prolong the PR interval, but searching Medline, we have found only one report of Wenckebach-type atrioventricular block in ethanol poisoning. We present a high-degree atrioventricular block in an ethanol-poisoned patient. Case presentation A 17-year-old woman with a non-contributory medical history ingested 3dcl of vodka and was found comatose. On arrival she was somnolent with nausea, tympanic temperature 36.0°C, pulse 70 counts/min, blood pressure 90/60 mmHg, respiratory rate 12 counts/min and SpO2 96% on room air. Her blood ethanol level was 130 mg/dL; other blood laboratory test results were normal. ECG revealed sinus rhythm, first-degree atrioventricular block with a PR interval of 0.32 seconds and intermittent second- and third-degree atrioventricular blocks with up to 4-second-long pauses that appeared 15-30 seconds after each vomiting. She was given thiethylperazine and vomiting resolved within an hour. ECG 12 hours after admission revealed a first-degree atrioventricular block with a PR interval of 0.24 seconds. One month later Holter monitor showed a sinus rhythm and first-degree atrioventricular block with a PR interval of 0.21 seconds. Vagal maneuvers did not provoke high-degree atrioventricular block. The echocardiogram was normal. Conclusion Acute ethanol poisoning has the potential to prolong the PR interval in adults with first-degree atrioventricular block and provoke intermittent second- and third-degree atrioventricular blocks, possibly by its direct inhibitory action on the conduction system and increasing parasympathetic tone due to nausea and vomiting.
Collapse
|
33
|
Heyerdahl F, Hovda KE, Bjornaas MA, Nore AK, Figueiredo JCP, Ekeberg O, Jacobsen D. Pre-hospital treatment of acute poisonings in Oslo. BMC Emerg Med 2008; 8:15. [PMID: 19025643 PMCID: PMC2605443 DOI: 10.1186/1471-227x-8-15] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2008] [Accepted: 11/24/2008] [Indexed: 11/23/2022] Open
Abstract
Background Poisoned patients are often treated in and discharged from pre-hospital health care settings. Studies of poisonings should therefore not only include hospitalized patients. Aims: To describe the acutely poisoned patients treated by ambulance personnel and in an outpatient clinic; compare patients transferred to a higher treatment level with those discharged without transfer; and study the one-week mortality after pre-hospital discharge. Methods A one-year multi-centre study with prospective inclusion of all acutely poisoned patients ≥ 16 years of age treated in ambulances, an outpatient clinic, and hospitals in Oslo. Results A total of 3757 health service contacts from 2997 poisoning episodes were recorded: 1860 were treated in ambulances, of which 15 died and 750 (40%) were discharged without transfer; 956 were treated in outpatient clinic, of which 801 (84%) were discharged without transfer; and 941 episodes were treated in hospitals. Patients discharged alive after ambulance treatment were mainly poisoned by opiates (70%), were frequently comatose (35%), had respiratory depression (37%), and many received naloxone (49%). The majority of the patients discharged from the outpatient clinic were poisoned by ethanol (55%), fewer were comatose (10%), and they rarely had respiratory depression (4%). Among the hospitalized, pharmaceutical poisonings were most common (58%), 23% were comatose, and 7% had respiratory depression. Male patients comprised 69% of the pre-hospital discharges, but only 46% of the hospitalized patients. Except for one patient, who died of a new heroin overdose two days following discharge from an ambulance, there were no deaths during the first week after the poisonings in the 90% of the pre-hospital discharged patients with known identity. Conclusion More than half of the poisoned patients treated in pre-hospital treatment settings were discharged without transfer to higher levels. These poisonings were more often caused by drug and alcohol abuse than in those who were hospitalized, and more than two-thirds were males. Almost half of those discharged from ambulances received an antidote. The pre-hospital treatment of these poisonings appears safe regarding short-term mortality.
Collapse
Affiliation(s)
- Fridtjof Heyerdahl
- Department of Acute Medicine, Ullevaal University Hospital, Oslo, Norway.
| | | | | | | | | | | | | |
Collapse
|
34
|
Ko JS, Kim JA, Do YS, Kwon MA, Choi SJ, Gwak MS, Lee JJ, Yang M. Prediction of the effect of injected ethanol on pulmonary arterial pressure during sclerotherapy of arteriovenous malformations: relationship with dose of ethanol. J Vasc Interv Radiol 2008; 20:39-45; quiz 45. [PMID: 19028113 DOI: 10.1016/j.jvir.2008.10.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2008] [Revised: 10/03/2008] [Accepted: 10/14/2008] [Indexed: 12/21/2022] Open
Abstract
PURPOSE To prospectively evaluate the effect of injected ethanol on pulmonary artery pressure during embolosclerotherapy of arteriovenous malformations (AVMs). MATERIALS AND METHODS This prospective study was conducted in 16 male and 14 female patients (37 sessions; mean age, 34 years; age range, 17-67 years) with AVMs during a 2-year period. The authors measured pulmonary artery pressure via a pulmonary artery catheter and ethanol levels from the pulmonary and radial arteries simultaneously within 3 minutes after each ethanol injection. The authors analyzed the relationship between pulmonary artery pressure and ethanol levels obtained from pulmonary and radial arteries with respect to both single and cumulative doses of ethanol injected. Retrospectively, patients were divided into two groups-those treated with and those treated without vascular occlusion techniques. RESULTS The radial arterial ethanol level showed good correlation with the pulmonary arterial ethanol level (r = 0.7). Single dose per injection was statistically related with pulmonary artery pressure (r = 0.5 vs 0.1 and P < .05 vs .29, respectively, in patients treated without and patients treated with vascular occlusion techniques), and the correlation coefficient between cumulative dose and pulmonary artery pressure was 0.2 and 0.3 in respective cases (P < .05 for both). The mean pulmonary artery pressure correlated with pulmonary arterial ethanol level irrespective of the use of vascular occlusion (r = 0.6 for both groups). CONCLUSIONS Pulmonary artery pressure reflected the pulmonary arterial ethanol level and was positively related to the dose of ethanol. Single dose per injection was predictive of pulmonary artery pressure only in patients treated without vascular occlusion techniques.
Collapse
Affiliation(s)
- Justin S Ko
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Korea
| | | | | | | | | | | | | | | |
Collapse
|