Abstract
IntroductionAcute ethanol ingestion can prolong the PR interval, but searching Medline, we have found only one report of Wenckebach-type atrioventricular block in ethanol poisoning. We present a high-degree atrioventricular block in an ethanol-poisoned patient.Case presentationA 17-year-old woman with a non-contributory medical history ingested 3dcl of vodka and was found comatose. On arrival she was somnolent with nausea, tympanic temperature 36.0°C, pulse 70 counts/min, blood pressure 90/60 mmHg, respiratory rate 12 counts/min and SpO2 96% on room air. Her blood ethanol level was 130 mg/dL; other blood laboratory test results were normal. ECG revealed sinus rhythm, first-degree atrioventricular block with a PR interval of 0.32 seconds and intermittent second- and third-degree atrioventricular blocks with up to 4-second-long pauses that appeared 15-30 seconds after each vomiting. She was given thiethylperazine and vomiting resolved within an hour. ECG 12 hours after admission revealed a first-degree atrioventricular block with a PR interval of 0.24 seconds. One month later Holter monitor showed a sinus rhythm and first-degree atrioventricular block with a PR interval of 0.21 seconds. Vagal maneuvers did not provoke high-degree atrioventricular block. The echocardiogram was normal.ConclusionAcute ethanol poisoning has the potential to prolong the PR interval in adults with first-degree atrioventricular block and provoke intermittent second- and third-degree atrioventricular blocks, possibly by its direct inhibitory action on the conduction system and increasing parasympathetic tone due to nausea and vomiting.
Highlights
Introduction: Acute ethanol ingestion can prolong the PR interval, but searching Medline, we have found only one report of Wenckebach-type atrioventricular block in ethanol poisoning
Acute ethanol poisoning in otherwise healthy adults has been associated with bradycardia
In studies with healthy volunteers it was shown that ethanol ingestion cause prolongation of the PR interval in electrocardiogram (ECG) [5,6], and in chronic alcoholics complete atrioventricular block in ECG, prolongation of His-ventricular conduction in electrophysiological studies and fibrofatty infiltration of the conduction system on autopsies were observed [1,8,9]
Summary
Ethanol abuse has been associated with tachyarrhythmias and increased mortality [1,2]. On arrival at the Emergency Department she was somnolent with tympanic temperature 36.0°C, pulse 70 counts/min, blood pressure 90/ 60 mmHg, respiratory rate 12 counts/min and SpO2 96% on room air She had nausea and vomited several times. ECG revealed sinus rhythm, first-degree atrioventricular block with a PR interval of 0.32 seconds and intermittent second- and third-degree atrioventricular blocks with up to 4-second-long pauses that appeared 15-30 seconds after each vomiting (Figures 1 and 2). On discharge 12 hours after admission, ECG revealed a sinus rhythm and first-degree atrioventricular block with a PR interval of 0.24 seconds.
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