Etiology of QT prolongation and T wave changes in chronic alcoholism.

Abstract

SUMMARYEtiology of QT prolongation and T wave high voltage was studied in 90 chronic alcoholics in relation to history of alcoholism, blood chemical values, heart rate and QRS voltage with a technic of multiple regression analysis. Incidences of QT prolongation (22%), T wave high voltage in lead V2 (9%), hypopotassemia (23%), hypocalcemia (26%) and hypomagnesemia (28%) were high, despite these examinations were done after relatively long abstention period (35 days on average). Sinus tachycardia (19%) and QRS high voltage (Sv1+Rv5 exceeding 4mV, 41%) were also frequent. Unexpectedly, QT interval did not correlate to serum electrolytes, including calcium. Major factors associated with QT prolongation were sinus tachycardia, longer abstention period and larger amount of daily alcohol consumption. Although the reason of each association was not quite clear, alcoholic myocardial damage may be a cause of QT prolongation. Voltage of T wave in lead V2 was sensitive to serum potassium level, but the observed tendency of hypopotassemia acted to the direction against high voltage of T wave. The sole factor positively associated with high voltage of Tv2 was high QRS voltage, which may be a manifestation of left ventricular hypertrophy.Additional Indexing Words: Alcoholic cardiomyopathy Hypopotassemia Hypocalcemia Hypomagnesemia T has long been recognized that prolongation of QT interval and various morphological abnormalities of ST segment and T wave are frequent on ECG in patients with chronic alcoholism.1)-6) Some of these changes were considered by Evans2) as indicative of alcoholic cardiomyopathy. Some varieties of ST-T changes are, however, rapidly reversible following abstention from alcohol,1),3) and may not be related to chronic cardiomyopathy.

Dispersion of the Corrected QT and JT Interval in the Electrocardiogram of Alcoholic Patients

“…It was not related to the electrolyte level. It is a higher frequency than the one found in two Japanese studies: Koide et al (1981) found it in 22% and Yokoyama et al (1992) in 46.9% of the examinees.…”

“…In the study of Koide et al (1981), a correlation with serum electrolyte level was not found. Our findings also correspond with the data of Day et al (1993).…”

“…In spite of the fact that alcohol consumption may protect against coronary heart disease, death from heart disease among alcoholic patients is the most important cause of mortality due to cardiac arrhythmias (Day et al, 1990; Kupari and Koskinen, 1998). In alcoholic patients, QT c prolongation was observed in 22% (Koide et al, 1981) to 46.9% of the cases (Yokoyama et al, 1992), and it was not associated with serum electrolyte levels. Measurements showed QT and QT c to be longer in the alcoholic patients than in the controls (Day et al, 1993).…”

“…The aim of this study was to analyze the corrected QT interval, its dispersion, and the QT interval index and compare them with the corrected JT interval, its dispersion, and the JT interval index in long‐term alcoholic users, by investigating the ventricular activation until the completion of repolarization (Day et al, 1993; Koide et al, 1981; Kupari and Koskinen, 1998; Rautaharju et al, 2004; Rossinen et al, 1999; Zhou et al, 1992).…”

Association of severity of depression, paroxetine use and markers of liver damage with QT interval duration in patients with alcohol dependence

“…However, in that study, the associated/confounding factor was hypomagnesemia stated by authors. The correlation between alcoholism and extended QTc interval has also been confirmed by other studies [20][21][22][23] . In the study of Bär et al 24 , a statistically significant prolongation of QTc interval in male persons with the symptoms of alcoholic abstinence (n = 18) in relation to the "pair matched" control group was established, but not in the case of syndrome of dependence without the abstinence syndrome (n = 15).…”