ST-SEGMENT CHANGES AND CATECHOLAMINE-RELATED MYOCARDIAL ENZYME-RELEASE DURING ALCOHOL-WITHDRAWAL

ST-segment changes and biochemical signs of myocardial injury, and the ir relation to sympatho-adrenergic activation and cardiac function, we re studied in a case series of 19 alcohol-dependent (DSM-III-R) men un dergoing in-hospital treatment for alcohol withdrawal. No patient had any clinically apparent heart disease. Analyses of ST-segment depressi ons greater than or equal to 0.1mV from 24 h ambulatory electrocardiog raphic recordings revealed horizontal or downsloping ST-segment depres sions in seven of the patients. The serum concentration of creatine ki nase (CKMB) the day after admission correlated with the urinary excret ion of adrenaline (r = 0.74, P<0.001) and noradrenaline (r = 0.71, P<0 .001). In the two patients with the highest adrenaline excretion and t he highest serum concentrations of CKMB and cardiac troponin T, horizo ntal ST-segment depressions were detected as well. The left ventricula r ejection fraction was greater than or equal to 0.65 (range 0.65-0.79 ) in all of the 17 alcoholic men who were examined by echocardiography . Our study shows that alcohol withdrawal is frequently associated wit h ST-segment abnormalities in men without impairment of heart function and that sympatho-adrenergic activation during withdrawal seems to in fluence the release of myocardial enzymes. Alcohol withdrawal should t hus be considered a condition in which acute cardiac complications may be expected in susceptible individuals.