Acute reversible left ventricular dysfunction secondary to alcohol

Abstract

A 48-year-old woman presented to the emergency department with confusion and shortness of breath. She admitted to an eight-year history of the ingestion of more than 600 mL of vodka per day. Within the month before presentation, she had increased her alcohol intake by drinking a large glass of 70% ethanol per day.Before this medical admission, the patient had two previous admissions for acute pancreatitis due to ethanol abuse. On both occasions, she had normal cardiac enzyme levels and no evidence of cardiac dysfunction, and a chest x-ray revealed no cardiomegaly or pulmonary edema. Her most recent admission with pancreatitis had occurred four months before the present admission.The patient came to the emergency room with a decreased level of consciousness, hallucinations and convulsions after 24 h to 48 h of abstinence from alcohol. Her clinical assessment was consistent with the symptoms of delirium tremens.Her baseline laboratory evaluation showed pancytopenia, abnormal liver function tests (Table 1) and elevated cardiac enzyme levels ( Table 2). The toxicology screen was negative (Table 1). The initial chest x-ray revealed a normal cardiothoracic ratio and no evidence of heart failure. Her electrocardiogram showed sinus tachycardia, a nonspecific T-wave abnormality and right axis deviation. The right axis deviation was unchanged from a previous electrocardiogram. She received aggressive volume resuscitation, and 24 h after admission, she developed severe dyspnea. A subsequent chest x-ray after fluid resuscitation revealed pulmonary edema.An echocardiogram performed within 24 h of admission and reviewed by two independent echocardiographers demonstrated severe global left ventricular systolic dysfunction, with an ejection fraction of 20% by modified Simpson's biplane method. The left ventricle was not dilated, and the right ventricle had normal function. The end-systolic dimension was 4.1 cm and the end-diastolic dimension was 5.0 cm (Figure 1). The patient's delirium tremens was treated with benzodiazepines, and her congestive heart failure was treated with diuretics and an angiotensin-converting enzyme (ACE) inhibitor. After diuresis, her chest x-ray returned to normal. The pancytopenia and elevated liver enzyme levels resolved within a few days of hospital admission, with abstinence from alcohol. A dipyridamole stress test performed seven days after admission revealed no myocardial ischemia. The patient's ejection fraction was calculated at 58%, and she was discharged on a diuretic, an ACE inhibitor and a beta-blocker.After one month of abstaining from alcohol, the patient was asymptomatic. A repeat echocardiogram revealed normal left ventricular function, with an ejection fraction of 62% by modified Simpson's biplane method. The end-systolic dimension was 3.3 cm and the end-diastolic dimension was 4.8 cm (Figure 2). Her cardiac medications were subsequently discontinued. Chronic excess alcohol use is a well-established cause of dilated cardiomyopathy. The clinical features are variable because patients ma...

Cardiac benefits after alcohol withdrawal

“…In fact, it is well known that LV function begins deteriorating before the patient becomes symptomatic 13,14,15 , and that an early withdrawal of alcohol consumption may improve significantly the prognosis. However, although it is demonstrated that alcohol is related to DCM, the real correlation between specific doses of ethanol, genetic susceptibility and cardiomyopathy development still remains unclear.…”

Clinical and echocardiogram profile of Cardiomyopathy at tertiary care centre

“…In present study genetic study was not possible due to resources limitations. Seth S et al 17 24 . Alcoholic cardiomyopathy (ACM) causes myocyte dysfunction, due to abnormalities in calcium homeostasis, and cause elevated levels of norepinephrine.…”

Reversible Alcoholic Cardiomyopathy: Letter to Editör

“…There are studies indicating that the effects of alcohol on myocarditis may be reversible. Additionally, significant improvements are determined clinically and echocardiografically in systolic heart functions at least 6 months after the alcohol is given up (9,10,11). Although this situation is presumed to be related to giving up alcohol before the development of fibrosis, it is still in question.…”