ABSTRACT
Alcohol ingestion commonly accompanies cocaine abuse, but the effects of chronic cocaine-alcohol abuse on the circulation are undefined. Therefore, to test for evidence of cocaine-alcohol cardiac dysfunction and interference with cardiovascular nervous system reflexes, 10 normal volunteers (group I), 8 asymptomatic alcoholic patients (group II), and 15 age matched, asymptomatic cocaine and alcohol abusers (group III) underwent screening two-dimensional echocardiography, electrocardiography, a series of autonomic nervous system tests, and upright bicycle exercises. Echocardiographic indices did not differ among groups. R wave voltage was increased in group III, probably primarily due to a smaller body surface area. Heart rate (HR) and/or systolic blood pressure (SBP) responses to 60 degree tilt and to hyperventilation differed in group III (decreased HR response, while SBP increased inappropriately). Despite excellent exercise tolerance, HR response to exercise in group III (compared to group I) was decreased. These results suggest impairment of certain autonomic nervous system reflexes and, possibly, sinus node dysfunction from cocaine-alcohol abuse.
Subject(s)
Alcoholism , Cardiovascular Physiological Phenomena , Cocaine , Substance-Related Disorders , Adult , Autonomic Nervous System/physiology , Blood Pressure/physiology , Echocardiography , Electrocardiography , Exercise Test , Heart Rate/physiology , Humans , Hyperventilation , Male , Mental Processes/physiology , Middle AgedABSTRACT
To test for early evidence of alcoholic cardiomyopathy and to assess changes in exercise response after abstinence, 12 asymptomatic alcoholic men (group 1) underwent maximal upright bicycle exercise radionuclide ventriculography two to six days after alcohol withdrawal. Six of these patients (group 1A) had similar testing two to four weeks later. Six control subjects (group 2) had repeated exercise tests without isotope study. Group 1 left ventricular ejection fraction response (LVEF) was normal. LVEF at similar workloads did not differ in group 1A (p = NS). However, unlike group 2 results, the linear regression line relating double product to exercise stage in group 1A was higher at first exercise (p less than 0.05), probably due to the effects of alcohol withdrawal. We conclude that radionuclide left ventriculographic findings in these patients do not support the concept of a preclinical alcoholic cardiomyopathy made apparent by exercise, and exercise very early after alcohol withdrawal is associated with an increased myocardial oxygen demand at any given workload.
