Acute coronary ischemia during alcohol withdrawal: a case report

Abstract

IntroductionThe potential of alcohol withdrawal to cause acute coronary events is an area that needs the urgent attention of clinicians and researchers.Case presentationWe report the case of a 52-year-old heavy-alcohol-using Sri Lankan man who developed electocardiogram changes suggestive of an acute coronary event during alcohol withdrawal. Despite the patient being asymptomatic, subsequent echocardiogram showed evidence of ischemic myocardial dysfunction. We review the literature on precipitation of myocardial ischemia during alcohol withdrawal and propose possible mechanisms.ConclusionsAlcohol withdrawal is a commonly observed phenomenon in hospitals. However, the number of cases reported in the literature of acute coronary events occurring during withdrawal is few. Many cases of acute ischemia or sudden cardiac deaths may be attributed to other well known complications of delirium tremens. This is an area needing the urgent attention of clinicians and epidemiologists.

Acute coronary events during alcohol withdrawal

“…We wish to highlight the potential for acute alcohol withdrawal to cause sudden cardiac death by precipitating acute coronary events and fatal cardiac arrhythmias and present some cases in our hospital that relate to this. There are a few case reports published in this regard . In addition a prospective study of electrocardiographic (ECG) tracings of 19 patients in alcohol withdrawal showed that seven of them had horizontal or down sloping ‘suspicious’ ST segment depressions though none of them complained of clinical symptoms .…”

“…There are several theories as to how withdrawal states may precipitate acute coronary events such as; stimulation of coronary vessels by a withdrawal‐induced adrenergic surge, imbalance of α and β adrenergic stimulation of coronaries , long term alcohol induced structural damage limiting coronary autoregulation at times of stress , magnesium deficiency and autonomic neuropathy .…”

Cardiac Arrest and Seizure Following Cannabis Overdose and Alcohol Withdrawal

“…Cannabis remains one of the most universally abused recreational drugs worldwide and its popularity has increased considerably due to the recent legalization and medicinal use [1][2][3][4][5]. Sometimes, cannabis overuse can lead to malignant arrhythmia leading to cardiac arrest [5,6].…”

“…Cannabis remains one of the most universally abused recreational drugs worldwide and its popularity has increased considerably due to the recent legalization and medicinal use [1][2][3][4][5]. Sometimes, cannabis overuse can lead to malignant arrhythmia leading to cardiac arrest [5,6]. Alcohol withdrawal following binge drinking combined with cannabis abuse can lead to malignant arrhythmia, seizure, and at times culminating in cardiac arrest [2,5,6].…”

“…Sometimes, cannabis overuse can lead to malignant arrhythmia leading to cardiac arrest [5,6]. Alcohol withdrawal following binge drinking combined with cannabis abuse can lead to malignant arrhythmia, seizure, and at times culminating in cardiac arrest [2,5,6]. We report two cases of ventricular fibrillation (VF) complicated with seizure caused by cannabis overdose and alcohol withdrawal following binge drinking.…”