Acute heavy alcohol intake increases silent myocardial ischaemia in patients with stable angina pectoris.

J. Rossinen, J. Partanen, P. Koskinen, L. Toivonen, M. Kupari, M. S. Nieminen

Department of Medicine, Helsinki University Central Hospital, Finland.

OBJECTIVE: To evaluate the effect of acute alcohol ingestion on myocardial ischaemia in patients with coronary heart disease and stable angina. DESIGN: Randomised crossover study using fruit juice with and without ethanol. SETTING: Division of cardiology in a university hospital. PATIENTS: 20 patients with stable exertional angina and > or = 50% luminal diameter narrowing of at least one major coronary artery. INTERVENTIONS: Each patient was studied on two separate days, once after administration of 1.25 g of ethanol per kilogram of body weight diluted to 15% in juice, and once after an equivalent volume of juice; both tests were in the evening and lasted 90 minutes. The patients were scheduled to have 8 periods of walking for 10 min according to a time table. An ambulatory electrocardiogram and the occurrence of anginal attacks were recorded and blood pressure and blood ethanol concentration were measured until the next morning. RESULTS: The blood ethanol concentration (mean (SD)) rose to 28.8 mmol/l (1.3 (0.4)/1000). Alcohol raised the systolic blood pressure from 132 (16) to 141 (14) mm Hg (P < 0.05 compared with juice). The mean heart rate increased from 57 (7) to 64 (8) beats/min (P < 0.05) for 13 hours after ethanol ingestion compared with juice. The total duration of ischaemia during the ethanol test was 3.5 (median, range 0-80) min, compared with 0 (range 0-67) min for the juice test (P < 0.05). The difference resulted mainly from more silent ischaemia after ethanol ingestion (2.3 (0-80) v 0 (0-67) min; P < 0.05). The ST segment depression time integral increased during the ethanol test (4.4 (0-170) mm x min) relative to that during the juice test (0 (0-103) mm x min; P < 0.01) and especially during the following 13 hours after alcohol (3.5 (0-123) mm x min) compared with juice (0 (0-67) mm x min; P < 0.005). There were no changes in the number, duration, or ST segment depression time integral of the episodes of symptomatic angina, indicating that ethanol augmented the appearance of silent ischaemia. CONCLUSIONS: Acute heavy ethanol drinking aggravates myocardial ischaemia in patients with stable angina pectoris.

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