Research work · 1959
THE ELECTROCARDIOGRAM OF ALCOHOLIC CARDIOMYOPATHY
William P. Evans
Heart
Abstract
The harmful effects of excessive alcohol consumption on the liver have long been recognized.A corresponding injury to the heart has not received the same attention except as part of the syndrome of beriberi attributable to thiamine deficiency.Not infrequently, however, when some form of heart disease is suspected on account of symptoms like breathlessness, palpitation, or chest pain, and when signs elicited from examination of the heart are equivocal, the true diagnosis may go undiscovered, especially if coronary arterial disease is too readily imputed as the cause of electro- cardiographic changes that may be present.In such instances, information about the quantity of alcohol consumed is seldom sought, and addiction to it is not rigorously canvassed.It should be known that when the ill-effects of alcohol on the myocardium are slight, withdrawal of alcohol can halt the pathological process, but should these earlier injurious effects go unheeded through some years, the resulting cardiomyopathy will no longer subside following such abstinence.It is for this reason that early myocardial damage from alcoholism is so important to detect, and it is the purpose of this paper to describe changes in the electrocardiogram that will facilitate this readier recognition. HOW THE PATIENTS WERE ASSEMBLEDThe first patient in this series attended at the request of his family doctor on account of breath- lessness and with a history of alcoholism over many years.His electrocardiogram presented a change that had not been noticed hitherto in healthy adults nor in patients with coronary arterial disease.The remaining 19 patients were assembled because of their bizarre symptoms and signs associated with characteristic electrocardiographic changes, and before a history of alcoholism was obtained.Indeed, in two cases where changes in the cardiogram by itself appeared to warrant the view that they had resulted from alcoholism, both patients denied habitual spirit drinking until inquiry of spouse and family doctor had confirmed such addiction through many years. THE ELECTROCARDIOGRAMIn 17 of the 20 patients the tracing showed changes that were confined to the T wave and followed characteristic designs.In the remaining three, the injurious effects of alcohol on the heart were suspected from finding extrasystoles of a certain order alongside other clinical signs that themselves supported the diagnosis.Thus, the cardiographic deformities have been allocated to two groups for the purpose of description, namely those that seemed by themselves distinctive, and those where the changes, although not entirely specific, suggested alcoholism as the cause.Distinctive Changes.A deformity in the T wave that affected the electrocardiogram in 17 patients assumed one of three designs.
DOI: 10.1136/hrt.21.4.445