A 35‐year‐old male was admitted for change in mental status. Past medical history was unremarkable, and he was not on any medications. Exam was significant for an awake but combative patient with incoherent speech. Fundi were normal. Electrocardiogram showed non‐sustained ventricular tachycardia, multiple premature ventricular complexes, and a prolonged QT interval (QTc = 794 msec). Urine toxicology was negative. Labs including CXR and CT head were normal. He was admitted to the Intensive care unit. An echocardiogram was normal. He required large doses of benzodiazepines and propofol. After 72 hours, repeat electrocardiogram showed gradual normalization of his QT interval, and he was discharged on the eighth day following admission. Electrocardiogram predischarge showed sinus rhythm with a QTc of 438 msec.
Acute alcohol withdrawal unmasks compensatory overactivity of certain parts of the nervous system. Bar et al. noted increased QT variability and thus increased repolarization lability in acute alcohol withdrawal that might add to the elevated risk for serious cardiac arrhythmias. These changes may in part be related to increased cardiac sympathetic aclivily or low potassium. Long QT syndrome, acquired or congenital, is a disorder of myocardial repolarization characterized by a prolonged QT interval on the electrocardiogram and is associated with an increased risk of torsades de pointes. Acquired long QT syndrome usually results from drug therapy, hypokalemia, or hypomagnesemia. Our patient was not on any known medications, and an echocardiogram showed a structurally normal heart. The risk for developing torsades in the presence of hypokalemia and/or hypomagnesemia is greatest in patients taking antiarrhythmic drugs. In stable patients, intravenous magnesium sulfate is first‐line therapy, being highly effective for both the treatment and prevention of recurrence of long QT‐related ventricular ectopic beats or TdP. Temporary transvenous overdrive pacing generally is reserved for patients with long QT‐related torsades who do not respond to intravenous magnesium.
The QTc interval is frequently prolonged during acute alcohol withdrawal; therefore, clinicians should be aware of this association and avoid the use of QT‐prolonging drugs and carefully monitor the rhythm in patients with severe alcohol withdrawal.
O. Olaoye none.