Zusammenfassung
Hintergrund:
Alkoholintoxikationen sind mit einer Verschlechterung kardialer autonomer Funktionen und einer höheren Mortalität assoziiert.
Patienten und Methodik:
Deshalb wurden prospektiv 14 Patienten (acht männlich, sechs weiblich; 24–59 Jahre) mit alleiniger Alkoholintoxikation und toxischen Blutalkoholspiegeln von 2,1–5,2‰ untersucht. Im Hinblick auf eine veränderte sympathische bzw. vagale Modulation wurde die Analyse der Herzfrequenzvariabilität (HRV) eingesetzt
Ergebnisse:
Die Ergebnisse zeigen, dass die HRV in Abhängigkeit vom Blutalkoholspiegel generell unterdrückt ist. Die beste Korrelation zu Blutalkoholspiegeln wurde nach logarithmischer Transformation in der Kurzzeitvariabilität der Frequenzdomäne (HF-Power) gefunden (p < 0,001). Ebenso war die Trennschärfe zwischen mittelschwerer versus schwerer Intoxikation hier am größten (p < 0,001). Während der Erholung erreichten alle HRV-Parameter in den ersten 24 h wieder signifikant höhere Werte (p < 0,001), eine erhöhte LF/HF-Ratio als Zeichen eines sympathischen Übergewichts blieb allerdings über den gesamten Untersuchungszeitraum bestehen (p < 0,001 gegenüber der Referenz). Unter der Vorstellung, dass eine sympathische Prädominanz das Auftreten lebensbedrohlicher Herzrhythmusstörungen begünstigt, war die LF/HF-Ratio zum Zeitpunkt des maximalen Auftretens von supraventrikulären und ventrikulären Arrhythmien signifikant erhöht (p = 0,001 gegenüber dem 24-h-Mittelwert von LF/HF).
Schlussfolgerung:
Diese Ergebnisse bestätigen einen länger anhaltenden hyperadrenergen Zustand während eines „holiday heart syndrome“. Das nach 24 h noch immer unterdrückte kardiale autonome Nervensystem, besonders des die vagale Aktivität beschreibenden Anteils, könnte für das späte Auftreten von kardiovaskulären Komplikationen verantwortlich sein, wenn weitere Triggerfaktoren hinzukommen.
Abstract
Background:
Alcohol intoxication is associated with deterioration of cardiac nervous function and increased mortality.
Patients and Methods:
Therefore, 14 patients (eight male, six female; 24–59 years) with pure ethanol intoxication and toxic levels of 210–520 mg/dl in the blood were prospectively investigated. For evaluation of changes in sympathetic and vagal modulation, an analysis of heart rate variability (HRV) was performed.
Results:
The results show that HRV in general is suppressed in dependence on blood alcohol levels. Most correlation was found in short-term variability of frequency domain (HF power) after logarithmic transformation (p < 0.001). Also the discrimination of moderate versus severe intoxication was greatest in HF power (p < 0.001). During recovery, all HRV parameters increased to significantly higher figures within 24 h (p < 0.001), but elevated LF/HF ratio as a sign of sympathetic predominance continued over the whole observation period (p < 0.001 to reference). Regarding the danger of possibly life-threatening arrhythmias, the LF/HF ratio showed significantly increased figures in the period of maximal development of supraventricular and ventricular arrhythmias (p = 0.001 to 24-h mean of LF/HF).
Conclusion:
These results underline the longer-lasting hyperadrenergic state during “holiday heart syndrome”. The still depressed cardiac autonomic nervous system after 24 h, especially in the vagal activity-describing part, might be basically relevant for later occurrence of cardiovascular complications, if additional trigger factors become present.
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Süfke, S., Fiedler, S., Djonlagiç, H. et al. Kontinuierliche Analyse der Herzfrequenzvariabilität zur Beurteilung des kardialen autonomen Nervensystems nach Alkoholintoxikation. Med Klin 104, 511–519 (2009). https://doi.org/10.1007/s00063-009-1110-y
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DOI: https://doi.org/10.1007/s00063-009-1110-y
Schlüsselwörter:
- Alkohol
- Intoxikation
- Autonomes Nervensystem
- Herzfrequenzvariabilität
- Sympathovagale Balance
- Herzrhythmusstörungen