Rajiv Gandhi University of Health Sciences
| |RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, |
| |BANGLORE, KARNATAKA |
| |ANNEXURE II |
| |PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION |
|1 |NAME OF THE CANDIDATE & ADDRESS (BLOCK LETTERS) | DR. KUSUMA. R |
| | |P.G IN PHYSIOLOGY |
| | |DEPARTMENT OF PHYSIOLOGY K.I.M.S., HUBLI. 580022 |
|2 |NAME OF THE INSTITUTION |KARNATAKA INSTITUTE OF MEDICAL SCIENCES, HUBLI. |
|3 |COURSE OF STUDY AND SUBJECT |M.D. PHYSIOLOGY |
|4 |DATE OF ADMISSION TO THE COURSE |28TH MAY 2010 |
|5 |TITTLE OF THE TOPIC |COMPARATIVE STUDY ON ELECTROCARDIOGRAM CHANGES AND HEART RATE |
| | |VARIABILITY AT REST AND DURING MODERATE EXERCISE IN CHRONIC |
| | |ALCOHOLICS. |
|6 |BRIEF RESUME OF THE INTENDED WORK: |
| |6.1 Need for the study: |
| |The association of alcohol consumption over many deleterious effects on human body are well documented, irrespective of the |
| |amount, nature and duration of alcohol consumption on various systems including cardiovascular system2, 16, 17. Chronic and |
| |heavy alcohol consumption has deleterious effects upon the cardiovascular system, may lead to progressive chronic cardiac |
| |dysfunction and cause congestive cardiomyopathy5. Alcohol (ethanol) is an incriminating factor having a direct cardiotoxic |
| |effect1. Damage to the autonomic nervous system affecting sudomotor, vasomotor, and cardiac function is a recognised feature of |
| |chronic alcohol dependence11. Evidence of cardiac malfunctions has been found in chronic alcoholics without overt failure12. |
| |Most of the observations relate the abnormal electrocardiogram (ECG) to organic myocardial disease. However, ECG changes may |
| |occur in chronic alcoholics without corresponding cardiomyopathy17. Observations have shown the presence of abnormal |
| |electrocardiogram at rest and during exercise13, also change in the regular pattern of heart rate variability6, 13, 17.. Heart |
| |rate variability (HRV) is a physiological phenomenon where the time interval between heart beats varies. It is measured by the |
| |variation in the beat-to-beat interval. Heart rate variability (HRV) has been used as a non invasive measure to evaluate |
| |neuroautonomic cardiovascular regulation. HRV measured in the frequency domain assesses the control of heart rate through |
| |rhythmic oscillations reflected in the RR intervals, allowing for the quantification of the neuroautonomic cardiovascular |
| |regulation6. Most of the clinical observations were based on selected patients with severe heart failure; the majority of |
| |asymptomatic alcoholics are not well studied15. Studies on chronic alcoholics who are apparently healthy, in whom ECG and HRV, |
| |at rest and during moderate exercise have shown changes13, 11. Studies have been conducted on alcoholics with regard to ECG |
| |changes are at rest, ECG changes at rest and during exercise or heart rate variability alone. Nevertheless all these specified |
| |parameters have not been studied in a single subject. |
| |Hence in the present study an attempt will be made to study and compare the possible changes (if any) in the electrocardiogram |
| |and heart rate variability in the same subject/ group in chronic alcoholics who are apparently healthy. |
| | |
| |6.2 Review of literature: |
| |A study conducted by Irma Laonigro et al1., shows that long term alcohol consumption is an important cause of dilated |
| |cardiomyopathy, although the amount and duration of alcohol that results in alcoholic cardiomyopathy has not been established. |
| |The typical ECG changes in inebriety are disturbance of heart rate having the nature of electric impulse generation disorder or |
| |impulse conduction pathololgy. |
| |A study was conducted by Trejbal .K, Mitro.P2 showed that patients with acute alcohol intoxication presented with pathological |
| |ECG changes, most frequent and prognostically significant in chronic alcoholics in patients with ischemic heart disease. ECG |
| |picture showed that there is significant extension in intervals with possible manifestation of latent conduction disturbance. |
| |Apart from heart rate disturbances it often shows non-specific repolarisation. |
| |Willy Abasebo et al3., conducted a study involving 84 patients, who were hospitalized with assumed acute ethanol intoxication. |
| |In the emergency room resting ECG was recorded and blood was collected for serum osmalility measurement used as proxy for |
| |ethanol levels. ECG segment durations were compared with controls and related intoxication level. It showed that, in subject |
| |with moderately elevated to high serum osmalilty, p wave and QTc intervals were prolonged compared with sober subjects. P wave, |
| |PR, QRS and QTc intervals were longer when the subjects had high blood ethanol levels. Ethanol at high to very high blood |
| |concentration caused several changes in ECG that might be associated with increased risk of arrhythmias. |
| |A study was conducted by J M Ryan, L G Howes7, showed that the association between alcohol intake and decreased heart rate |
| |variability may be secondary to an increase in heart rate rather than a central or peripheral effect of alcohol on cardiac vagal|
| |nerve activity. |
| |A study was conducted by Pitala A, et al8., which included 17 alcoholics, 24-55 years of mean age were examined. They are |
| |abstainers for 2-6 years. The cardiac autonomic nervous system function was evaluated using the heart rate variability |
| |measurement. The HRV was registered using V6 ECG lead. It was noted that the mean RR period wasn’t significantly changed. The |
| |result indicates on the maintenance of HRV disorders in chronic alcoholics, during abstinence. |
| |A study was conducted by Simon C malpas et al11., on cardiac autonomic function in 23 alcohol dependent men by standard tests of|
| |autonomic function and measurement of 24 hour heart rate variability. The results of standard tests of autonomic function did |
| |not distinguish between the alcohol dependent men with normal autonomic function and controls. The differences in heart rate |
| |variability between this group changes in autonomic integrity. |
| |A study was conducted by Yokayama A et al12., included heart rate variation in 37 male alcoholics who were admitted within |
| |48hours of last drinking. Study suggested that the disturbances of heart rate variation in alcoholics are reflecting the |
| |deterioration of autonomic nervous system on alcohol withdrawal stage. |
| |A study was conducted by Kochegurov V N13 included recording of ECG at rest and during the step test in 231 alcoholic patients |
| |and clinically normal males. The most common ECG changes recorded at rest were shortened PQ interval, lengthened QT, rhythm and |
| |conductivity disorders, flattened P waves, and whereas typical exercise associated changes were elevated systolic parameters. As|
| |alcoholism progressed there was an obvious tendency to increased incidence of conductivity disorders, flattened p waves and |
| |elevated systolic values during exercise. |
| |Koide T et al14., conducted a study involving 90 chronic alcoholics in relation to history of alcoholism, blood chemical values,|
| |heart rate and QRS voltage with a technique of multiple regression analysis. It showed that the changes in ECG noted in the |
| |duration of QT interval did not correlate with the obtained values of serum electrolytes. |
| |A study was conducted by G F levi, et al16., included 43 subjects and 34 normal controls. There was no significant difference |
| |between the heart rates of the normal and alcoholic groups. The correlation coefficients for each pair of systolic time interval|
| |and heart rate showed a different pattern in the normal subjects as compared with the alcoholics. It concluded that even regular|
| |intake of wine appears to be as deleterious in this respect as the other form of alcoholism. |
| |A study was conducted by George Sereny 17, included 1000 chronic alcoholics, who were examined and analysed for their ECG. |
| |Evidence presented that excessive consumption of alcohol, in the absence of organic heart disease, may produce changes in ECG. |
| |The predominant abnormalities were sinus tachycardia and non specific T wave changes. These abnormalities were present in the |
| |majority of the patients, provided that ECG was taken while the patients were still intoxicated. It suggested that the changes |
| |are caused by two known effects of alcohol stimulation of catecholamine secretion from the adrenal medulla and alteration of |
| |cell membrane permeability. |
| |A study was conducted by R G Priest et al18., included 37 in-patients with alcoholism. Out of which 20 had abnormal ECGs. The |
| |abnormal ECGs were significantly associated with body weight, occurring seldom in underweight patients and never in obese |
| |patients. They showed a tendency in the presence of abnormal cardiovascular signs. |
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| | |
| |6.3 Objectives of the study: |
| |To study the electrocardiogram changes and heart rate variability at rest in chronic alcoholics. |
| |To study the electrocardiogram changes and Heart rate variability during moderate exercise in chronic alcoholics. |
| |To compare the ECG changes and heart rate variability at rest in chronic alcoholics with controls. |
| |To compare the ECG changes and heart rate variability during moderate exercise in chronic alcoholics with controls. |
|7 | Materials and methods |
| |Source of data: |
| |Male aged between 30 and 50 years with a history of more than 5 years of |
| |alcohol consumption in and around HUBLI. |
| | |
| |Inclusion criteria |
| |50 men aged between 30 – 50 years with history of alcohol intake for duration of > 5 years of HUBLI without any known cardiac |
| |illness. |
| |Exclusion criteria |
| |Male below 30 years and above 50 years. |
| |Male with history of alcohol consumption ................
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