Case Report

Adrenergic Inhibition with Dexmedetomidine to Treat Stress Cardiomyopathy during Alcohol Withdrawal: A Case Report and Literature Review

Table 1

Case reports of stress cardiomyopathy in patients with acute alcohol withdrawal. VTach, ventricular tachycardia; VFib, ventricular fibrillation; CXR, chest X-ray; CIWA, Clinical Institute Withdrawal Assessment of Alcohol scale.

Age/sexOnset (from last drink)Clinical features of withdrawalPresenting features of stress cardiomyopathyNotable case featuresReference

64/MAt least 5 daysNot described in case reportDecline in level of consciousness, sustained VTach with degeneration to VFib, cardiopulmonary arrest; subsequent ST segment elevation and later T wave inversionQT prolongation on admission; patient required cardiopulmonary resuscitation[12]

49/FNot described in case reportWithdrawal seizure after episode of acute intoxication (time between events not described in case report)Decreased level of consciousness, decreased O2 saturation, rapid hypotension, infiltrate on CXR, ST elevation, and T wave inversion[13]

25/FNot described in case reportSeizure episodeTorsades de pointes with degeneration to VFib (in route to hospital), T wave inversion (3 hours after resuscitation) with QT prolongationCocaine use 3 days prior to seizure[14]

61/M36 hoursNot described in case reportChest pain radiating to jaw, tachycardia, ST elevation, and T wave inversion[15]

63/M6-7 daysGrand mal seizure 3 days after alcohol cessationSevere dyspnea, pulmonary edema, T wave inversion, QT prolongationResolution of stress cardiomyopathy confirmed at 10 weeks[16]

56/M5 days after hospitalizationConfusion, severe asthenia, anorexia, tremorTachycardia, decreased O2 saturation, pulmonary edema, orthopnea, pathologic Q waves, elevated troponin I (1.08 ng/mL)3 days after onset of stress cardiomyopathy, ECG showed diffuse T wave inversion and QT prolongation[17]

57/F<24 hours2 episodes of seizures and confusion the morning after a night of binge drinking, fever, tachycardia, agitation, diaphoresis, tremulousness, Hypotension, T wave inversion, QT prolongation, elevated troponin I (4.075 micrograms/L), subsequent elevated jugular venous pressure and peripheral edemaHistory of alcohol-related seizures; patient required vasopressor support; reversal of left ventricular wall motion abnormalities 12 days prior to admission[18]

45/F96–120 hoursEpigastric pain, nausea and vomiting 72 hours after discontinuation of alcohol, tremulousness, tachycardia, CIWA of 9T wave inversion, troponin elevation (0.974 ng/mL)[19]

57/F>10 daysIntense agitation, tachycardia, tachypneaTachycardia, tachypnea, pulmonary edema, Q waves, ST elevation, T wave inversion, subsequent ECG revealed diffuse T wave inversion and QT prolongationPatient admitted for elective thoracotomy; patient was reintubated after procedure due to hypoxemic respiratory failure; dexmedetomidine used in the treatment of withdrawal symptoms; patient later developed cardiogenic shock and required vasopressors and intra-aortic balloon pump[20]