A Case of Chronic Alcoholism and Torsades de Pointes

Daniel C. Sacher^1,

¹Department of Internal Medicine, Drexel University College of Medicine, Hahnemann University Hospital, Philadelphia, PA, USA

Cite this paper:
Daniel C. Sacher. A Case of Chronic Alcoholism and Torsades de Pointes. American Journal of Medical Case Reports. 2018; 6(6):117-120. doi: 10.12691/ajmcr-6-6-5

Abstract

Torsades de pointes is a form of polymorphic ventricular tachycardia due to prolonged ventricular repolarization represented by a prolonged QT interval on electrocardiogram. Common causes of QT prolongation are usually considered in the clinical setting, such as electrolyte imbalances, medication side effects, congenital syndromes. As recent research has proposed, long-term excessive alcohol use may also be a contributing factor. The effects of alcohol on the heart have been studied extensively, showing that chronic exposure leads to cellular events and structural changes in the heart that may ultimately result in adverse clinical events. This case report presents a patient with a history of chronic alcoholism that experienced torsades de pointes and sudden cardiac death during hospitalization for a severe chronic obstructive pulmonary disease exacerbation. She was given macrolide antibiotics despite a prolonged QTc on electrocardiogram with a history of prior syncopal events. While macrolide antibiotics are known to cause QTc prolongation, chronic alcohol use has also been shown to be associated with QT prolongation. Moreover, QT prolongation may be a predictor of sudden cardiac death in alcoholics. In addition to common medication class side effects, the effects of commonly abused and readily accessible substances such as alcohol, should also be taken into consideration.

Keywords:
torsades de pointes prolonged QT interval alcoholism sudden cardiac death

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References:

[1]	National Institute on Alcohol Abuse and Alcoholism, “Alcohol Facts and Statistics,” www.niaaa.nih.gov. Updated June 2017.
[2]	Goldman, L., Schafer, A.I., Goldman-Cecil Medicine, Elsevier, Philadelphia, 2016, 320-339.
[3]	Greenspon, A.J., Schaal, S.F., “The “holiday heart:” electrophysiologic studies of alcohol effects in alcoholics,” Ann Intern Med, 98 (2): 135-139. February 1983.
[4]	Guzzo-Merello, G., Cobo-Marcos, M., Gallego-Delgado, M., Garcia-Pavia, P., “Alcoholic cardiomyopathy,” World J Cardiol, 6 (8): 771-781. August 2014.
[5]	Li, Z., Guo, X., Liu, Y., Sun, G., Sun, Y., Guan, Y., et al., “Relation of heavy alcohol consumption to QTc interval prolongation,” Am J Cardiol, 118 (8): 1201-1206. July 2016.
[6]	Newby, D.E., Grubb, N.R., Bradbury, A., Davidson’s Principles and Practice of Medicine, Elsevier, 2017, 525-641.
[7]	Moss, A.J., “Measurement of the QT interval and the risk associated with QTc interval prolongation: a review,” Am J Cardiol, 72 (6): B23-B25. August 1993.
[8]	Pedersen, C.T., Kay, G.N., Kalman, J., Borggrefe, M., Della-Bella, P., Dickfeld, T., et al., “EHRA/HRS/APHRS Expert Consensus on Ventricular Arrhythmias,” Heart Rhythm, 11 (10): e166-196. October 2014.
[9]	Bonow, R.O., Mann, D.L., Zipes, D.P., Libby, P., Braunwald, E., Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine, Elsevier, Philadelphia, 2012, 653-686.
[10]	Viskin, S., “Long QT syndromes and torsade de pointes,” The Lancet, 354 (9190): 1625-1633. November 1999.
[11]	Al-Khatib, S.M., Allen Lapointe, N.M., Kramer, J.M., Califf, R.M., “What clinicians should know about the QT interval,” JAMA, 289 (16): 2120-2127. April 2003.
[12]	Letsas, K.P., Efremidis, M., Kounas, S.P., Pappas, L.K., Gavrielatos, G., Alexanian, I.P., et al., “Clinical characteristics of patients with drug-induced QT interval prolongation and torsade de pointes: identification of risk factors,” Clin Res Cardiol, 98 (4): 208-212. April 2009.
[13]	Collier, B.R., Miller, S.L., Kramer, G.S., Balon, J.A., Gonzalez, L.S. 3rd. “Traumatic subarachnoid hemorrhage and QTc prolongation,” J Neurosurg Anesthesiol, 16 (3): 196-200. July 2004.
[14]	Sereny, G., “Effects of alcohol on the electrocardiogram,” Circulation, 44 (4): 558-564. October 1971.
[15]	Koide, T., Machida, K., Nakanishi, A., Ozeki, K., Mashima, S., Kono, H., “Cardiac abnormalities in chronic alcoholism,” Jpn Heart J, 13 (5): 418-427. 1972.
[16]	Lorsheyd, A., de Lange, D.W., Hijmering, M.L., Cramer, M.J., van de Wiel, A., “PR and QTc interval prolongation on the electrocardiogram after binge drinking in healthy individuals,” Neth J Med, 63 (4): 59-63. April 2005.
[17]	Day, C.P., James, O.F.W., Butler, T.J., Campbell, R.W.F., “QT prolongation and sudden cardiac death in patients with alcoholic liver disease,” The Lancet, 341 (8858): 1423-1428. June 1993.
[18]	Koide T, Ozeki K, Kaihara S, Kato A, Murao S, Kono H. “Etiology of QT prolongation and T wave changes in chronic alcoholism,” Jpn Heart J, 22 (2): 151-166. March 1981.
[19]	Rossinen, J., Sinisalo, J., Partanen, J., Nieminen, M.S., Viitasalo, M.. “Effects of acute alcohol infusion on duration and dispersion of QT interval in male patients with coronary artery disease and in healthy controls,” Clin Cardiol, 22 (9): 591-594. September 1999.