Cardiovascular changes in alcoholic patients during withdrawal phase

Background: Haemodynamic changes such as tachycardia, arterial hypertension and elevated cardiac output are usual in alcohol withdrawal syndrome (AWS). Objective: We investigated central haemodynamics in alcoholic patients non-invasively in different phases of AWS parallel to recording AWS symptoms. Material and methods: 22 alcoholic patients during different phases of withdrawal were investigated 1, 2, 3 and 10 days after admission for detoxification. The intensity of alcohol withdrawal syndrome (AWS) was evaluated with a rating scale. Stroke volume (SV) was measured with an impedance cardiogram, systolic (SBP), diastolic (DBP), and mean blood pressures (MBP) were measured with a sphygmomanometer by Korotkoff, and heart rate (HR) was obtained from an electrocardiogram (ECG). Cardiac output (CO) and total peripheral resistance (TPR) were calculated. Results: The intensity of AWS decreased towards Day 10. Concomitantly, MBP decreased which was attributable to a reduction of both SBP and DBP. Changes in TPR were proportional to the level of change in SV. The level of HR measured on Day 10 differed from the HR on Day 1 but not from rates on Days 2 and 3. The CO tended to be maintained at the same level during AWS. Depending on the level of CO on Day 1, the haemodynamic parameters underwent different courses towards the end of AWS. When CO was low (<6 l), TPR decreased and CO tended to be at the same level. The opposite was true when CO was high (> 6 l). Conclusion: These results suggest that the adaptive capacity of haemodynamics appears to be preserved in patients with alcohol withdrawal without evident cardiac diseases. The cardiovascular system of alcoholic patients tends to adapt to the changing level of activity in the sympathetic nervous system during alcohol withdrawal (German J Psychiatry 2000;3:1-6).