For many years, moderate alcohol intake and its effect on health have been subject to much debate, particularly concerning cardiovascular health. Indeed, light-to-moderate use of alcohol has been associated with properties that may protect heart health. However, according to the Centers for Disease Control and Prevention (CDC), although past research has shown protective health benefits associated with moderate alcohol consumption, more recent evidence demonstrates this may not be the case. Currently, it is impossible to conclude the net health effects of average alcohol consumption. However, it is well known that heavy drinking is associated with various adverse health consequences such as high blood pressure, stroke, liver disease, and cancer. Heavy drinking can also be detrimental to heart health in the short term, even in younger individuals. In adolescents, alcohol is the most frequently used psychoactive substance, and health issues related to alcohol intoxication in this population have been a cause for increased health service utilization in recent decades. Alcohol use is associated with up to 20% of adolescent deaths.
Among common reasons for death in adolescents related to alcohol is cardiovascular toxicity. The phenomenon of QT interval prolongation is of particular interest, an electrophysiologic change that can be a harbinger of life-threatening ventricular arrhythmias. Although it is known that alcohol intoxication can prolong the QT interval, until recently, the prevalence of this condition in adolescents under the acute influence of alcohol was unknown. A recent retrospective observational study evaluated adolescents between the ages of 10-18 under the influence of alcohol who were admitted to the emergency room between 2009 and 2019. Electrocardiograms (ECG) which measure the heart's electrical activity, were taken during acute intoxication and compared to a reference ECG taken one year before or after admission. Patients with known heart disease were excluded from the study. Although no ventricular arrhythmias were documented, QT prolongation occurred in approximately 10% of patients with acute alcohol intoxication and was more prevalent in females. Another finding was the association of low serum potassium levels with adolescent QT prolongation.
One major limitation of this study was the low percentage of reference ECGs obtained. Therefore, it was difficult to determine whether QT prolongation resulted from intoxication or if it was the patient's normal ECG. Although the measured prevalence of 12% of adolescents having a QT longer than 60 milliseconds may be overestimated, it was noted that cutoff values were based on the upper 5% of a cohort that included family members that were genotype-negative for long QT syndrome. Therefore, such a high prevalence of adolescents with this level of QT prolongation at baseline would be unlikely. Furthermore, although findings are inconclusive, given the risk of life-threatening cardiac arrhythmias associated with QT prolongation, clinicians should be aware of the possibility of QT prolongation in adolescents who present with acute alcohol intoxication and obtain an ECG at the time of presentation. In addition, low levels of serum potassium should be corrected.
Sources: Centers for Disease Control and Prevention, European Journal of Pediatrics