ALCOHOL WITHDRAWAL AND OVERLAPPING FIBERS: A BRIDGE TO A CORONARY SYNDROME

TOPIC: Cardiovascular Disease TYPE: Medical Student/Resident Case Reports INTRODUCTION: Delirium tremens is characterized by a sympathetic overdrive after acute alcohol reduction. In chronic users, this catecholamine surge especially dangerous due to the long-standing perivascular cell damage in microvasculature of heart [1]. Furthermore, coronary muscle bridges increase arterial wall tension, causing local endothelial dysfunction [2]. CASE PRESENTATION: A 63-year-old male with history artery disease, failure reduced ejection fraction (HFrEF) and polysubstance abuse (alcohol, cocaine tobacco) presented typical chest pain. Physical examination revealed hypertension tachycardia. Troponins were 0.069 ng/ml (reference range: less than 0.015) urine toxicology was positive for cocaine. Electrocardiogram (ECG) showed new T wave inversions lateral leads (Figure 1). He stabilized medical management started on lorazepam protocol withdrawal but developed visual hallucinations agitation shortly afterwards. rhythm change noticed telemetry strip patient delirium had no active complaints. Repeat ECG left bundle branch block 2). The underwent catheterization where 40% stenosis distal bridge documented anterior descending artery. EF 18%. No stent placed advised an implantable cardioverter defibrillator (ICD) [3]. discharged optimal therapy wearable automated external refused further interventions. three months later outpatient nuclear stress test improvement 29% 3). DISCUSSION: Alcohol undoubtedly produces abrupt catecholaminergic surge. Consequently, increased oxygen consumption vasoconstriction already damaged myocardium, worsens rate cardiomyocyte injury. current protocols recommend benzodiazepines as first-line treatment withdrawal. These medications, combination delirium, may skew appropriate clinical assessment. Moreover, atherosclerotic plaque formation elevated shear Unfortunately, surgical myotomy, intracoronary stenting, even bypass graft surgery have been used bridges, long-term outcomes remain uncertain. cornerstone remains therapy. CONCLUSIONS: This case illustrates risks involving care patients established disease. hyperadrenergic state conjunction injury from bridge, increases significantly risk syndrome (ACS). Active medications mask symptoms ACS, making diagnosis more challenging. REFERENCE #1: Factor SM. Intramyocardial small-vessel disease alcoholism. Am Heart J. 1976 Nov;92(5):561-75. doi: 10.1016/s0002-8703(76)80075-0. PMID: 983932. #2: Lee MS, Chen CH. Myocardial Bridging: An Up-to-Date Review. J Invasive Cardiol. 2015 Nov;27(11):521-8. Epub May 15. 25999138; PMCID: PMC4818117 #3: Yancy CW, Jessup M, Bozkurt B, et al. 2013 ACCF/AHA Guideline Management Failure. Circulation. 2013;128(16). doi:10.1161/cir.0b013e31829e8776 DISCLOSURES: relevant relationships Abdul Rahman Al Armashi, source=Web Response Ameed Bawwab, Kanchi Patell, Keyvan Ravakhah, Francisco Somoza-Cano,