Severe reversible cardiac failure associated with methanol intoxication

Abstract

Summary:Methanol intoxication produces a well recognized clinical picture characterized by gastrointestinal, ocular and nervous system symptoms. The effect of poisoning on the cardiovascular system has not been well documented.We report the case of a 55 year old man whose acute methanol intoxication caused severe reversible cardiac failure. This represents the first description of an association between methanol toxicity and acute cardiac dysfunction in man.

Impact of methanol intoxication on the human electrocardiogram

“…One case report documented a patient with methanol overdose that developed right bundle branch block in addition to left anterior fascicular block, paroxysmal atrial fibrillation and increased left ventricular end-diastolic and end-systolic dimensions [6]. In a case series of 8 men with methanol overdose published by Weisberger and Maclaughlin [7], ECG changes were observed in 7 men and these [8], described right atrial overload with tall peaked P-waves, clockwise rotation with a shift of transitional zone to the right, and right ventricular strain with tall R-waves in the right precordial leads [8].…”

“…Furthermore, there is some disparity in our results as compared to what has been reported previously in the literature. The study by Cavalli et al [6] focused on describing the possible relationship between methanol intoxication and cardiac dysfunction. As such, the authors reported some ECG changes as part of the description.…”

“…Methanol and formic acid can decrease the heart rate and the contractility of the myocardium [6]. Since formic acid can inhibit cytochrome oxidase activity in intact mitochondria, it has the potential to cause histotoxic hypoxia if the inhibition occurs at the terminal end of the respiratory chain [5].…”

“…Previous reports have documented changes in axis, non-specific T-wave changes, minor changes in QRS complexes and prolongation of the QT c interval [6][7][8].…”

Electrocardiographic Manifestations in Acute Methanol Poisoning Cannot Predict Mortality

“…To the best of our knowledge, no literature has considered electrocardiographic (ECG) abnormalities as potential mortality predictors. Articles that do report ECG changes in patients poisoned with methanol are inconsistent (7,(22)(23)(24)(25)(26). In addition, little is known about the relationship between ECG parameters and metabolic/electrolyte disturbances as well as the signs and symptoms of methanol poisoning.…”