Associação de miopatia e miocardiopatia alcoólicas: estudo clínico, eletroneuromiográfico e histopatológico do músculo esquelético em 10 casos de miocardiopatia alcoólica

Freitas, Marcos R. G. de; Marques, Hélio Ayres; Silva, João Batista Guedes e

doi:10.1590/S0004-282X1988000400001

Resumos

Apesar do acometimento do miocárdio e do músculo esquelético pelo álcool etílico vir sendo estudado minuciosamente, o comprometimento simultâneo destes dois tecidos pelo etanol não tem merecido destaque na literatura médica. Selecionamos dez enfermos que apresentavam miocardiopatia alcoólica e os submetemos a minucioso exame neurológico, a dosagens plasmáticas de enzimas musculares, a eletroneuromiografia e a biópsia muscular com exame do fragmento Delas microscopias convencional e eletrônica. Dos dez pacientes, somente um apresentava fraqueza e atrofia proximal dos membros inferiores com alterações eletroneuromiográficas e histológicas musculares, caracterizando a forma clínica da miopatia crônica produzida pelo álcool. O exame eletromiográfico revelou-se normal em um paciente, com padrão do tipo miopático, em oito, e neuropático, em um enfermo. O estudo do tecido muscular, à microscopia óptica, mostrou-se normal somente em um paciente. Os outros nove apresentavam alterações caracterizadas por proliferação de núcleos subsarcolemais, atrofia de fibras, imagens de hialinização e vacuolização, perda da estriação de fibra muscular e atrofia em grupo. Na ultramicroscopia, um exame revelou-se normal. Os outros mostraram edema intracelular, dissociação de miofilamentos, alteração da linha Z, modificação de forma e aumento do número de mitocôndrias, espessamento do sarcolema, vacuolização e aumento dos grânulos de glicogênio. Concluímos haver íntima relação entre a miocardiopatia e a miopatia alcoólicas, sendo comum o acomentimento simultâneo destas duas estruturas.

Myocardial and skeletal muscle impairment caused by alcohol has been thoroughly studied. Nevertheless, the simultaneous involvement of those tissues by ethanol has not been broached in medical literature. We have studied ten patients undergoing alcoholic cardiomyopathy. They were subjected to a detailed neurological examination, muscle enzymes serum level determinations, electromyography, and muscle biopsy with analysis of the tissue by usual histological techniques and by electron microscopy. Only one of ten patients exhibited proximal weakness and atrophy of the lower limbs, the electromyographic and histological findings correlating with the clinical feature of the chronic muscle disease due to alcohol consumption. The electromyographic findings included muscle disease in eight patients, neuron disease in one patient and no changes at all in the tenth patient. In one patient only, the skeletal muscle proved normal when examined by conventional histological techniques. In the other nine patients there were several minimal changes, such as the proliferation of nuclei beneath the sarcolemma, atrophy of fibers, hyalinisation, vacuolation, loss of muscle fiber striae, and atrophy of groups of fibers. Electron microscopy demonstrated the following changes in nine patients: intracellular edema, dissociation of myofilaments, alteration of the Z line, changing in the shape and increase in the number of mitochondriae, thickening of sarcolemma, and vacuolation and increase of the glycogen granules. Since all patients exhibited skeletal muscle injury, we concluded that there is a close relation between alcoholic cardiomyopathy and skeletal muscle disease.

Marcos R. G. de Freitas^I; Hélio Ayres Marques^II; João Batista Guedes e Silva^III

^IProfessor Adjunto e Chefe do Serviço - Trabalho da Disciplina de Neurologia da Faculdade de Medicina da Universidade Federal Fluminense (U.F.F.)

^IIProfessor Adjunto, responsável pelo Setor de Eletroneuromiografia - Trabalho da Disciplina de Neurologia da Faculdade de Medicina da Universidade Federal Fluminense (U.F.F.)

^IIIProfessor Adjunto de Anatomia Patológica - Trabalho da Disciplina de Neurologia da Faculdade de Medicina da Universidade Federal Fluminense (U.F.F.)

RESUMO

Apesar do acometimento do miocárdio e do músculo esquelético pelo álcool etílico vir sendo estudado minuciosamente, o comprometimento simultâneo destes dois tecidos pelo etanol não tem merecido destaque na literatura médica. Selecionamos dez enfermos que apresentavam miocardiopatia alcoólica e os submetemos a minucioso exame neurológico, a dosagens plasmáticas de enzimas musculares, a eletroneuromiografia e a biópsia muscular com exame do fragmento Delas microscopias convencional e eletrônica. Dos dez pacientes, somente um apresentava fraqueza e atrofia proximal dos membros inferiores com alterações eletroneuromiográficas e histológicas musculares, caracterizando a forma clínica da miopatia crônica produzida pelo álcool. O exame eletromiográfico revelou-se normal em um paciente, com padrão do tipo miopático, em oito, e neuropático, em um enfermo. O estudo do tecido muscular, à microscopia óptica, mostrou-se normal somente em um paciente. Os outros nove apresentavam alterações caracterizadas por proliferação de núcleos subsarcolemais, atrofia de fibras, imagens de hialinização e vacuolização, perda da estriação de fibra muscular e atrofia em grupo. Na ultramicroscopia, um exame revelou-se normal. Os outros mostraram edema intracelular, dissociação de miofilamentos, alteração da linha Z, modificação de forma e aumento do número de mitocôndrias, espessamento do sarcolema, vacuolização e aumento dos grânulos de glicogênio. Concluímos haver íntima relação entre a miocardiopatia e a miopatia alcoólicas, sendo comum o acomentimento simultâneo destas duas estruturas.

SUMMARY

Myocardial and skeletal muscle impairment caused by alcohol has been thoroughly studied. Nevertheless, the simultaneous involvement of those tissues by ethanol has not been broached in medical literature. We have studied ten patients undergoing alcoholic cardiomyopathy. They were subjected to a detailed neurological examination, muscle enzymes serum level determinations, electromyography, and muscle biopsy with analysis of the tissue by usual histological techniques and by electron microscopy. Only one of ten patients exhibited proximal weakness and atrophy of the lower limbs, the electromyographic and histological findings correlating with the clinical feature of the chronic muscle disease due to alcohol consumption. The electromyographic findings included muscle disease in eight patients, neuron disease in one patient and no changes at all in the tenth patient. In one patient only, the skeletal muscle proved normal when examined by conventional histological techniques. In the other nine patients there were several minimal changes, such as the proliferation of nuclei beneath the sarcolemma, atrophy of fibers, hyalinisation, vacuolation, loss of muscle fiber striae, and atrophy of groups of fibers. Electron microscopy demonstrated the following changes in nine patients: intracellular edema, dissociation of myofilaments, alteration of the Z line, changing in the shape and increase in the number of mitochondriae, thickening of sarcolemma, and vacuolation and increase of the glycogen granules. Since all patients exhibited skeletal muscle injury, we concluded that there is a close relation between alcoholic cardiomyopathy and skeletal muscle disease.

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Disciplina de Neurologia do Departamento de Medicina Clínica da U.F.F. - Hospital Universitário Antonio Pedro - Rua Marquês do Paraná - 24200 Niterói RJ - Brasil.

1. Berk SL, Block PJ, Toselli PA, Ullrick WC - The effects of chronic alcohol ingestion in mice on contractile properties of cardiac and skeletal muscle: a comparision with normal and dehydrated-malnourished controls. Experientia 31: 1302, 1975.
2. Carlsson C, Dencker SJ, Henriksson KG, Magnussor R, Petersen I, Riman E - Clinical, histological and electromyographical studies in chronic alcoholics. Acta Neurol Scand (supl) 48: 425, 1972.
3. Curran JR, Wetmore SJ - Alcoholic myopathy. Dis Nerv System 33: 19, 1972.
4. Dubowitz V, Brooke MH - The procedure of muscle biopsy. In Dubovitz V, Brooke MH - Muscle Biopsy: a Modern Approach. WB Saunders. London, 1973, pg 5-20.
5. Ekbom K, Hed R, Kirstein L, Astrom KE - Muscular affections in chronic alcoholism. Arch Neurol 10: 449, 1964.
6. Erlenbron JW, Pilz CG - Paroxismal myoglobinuria associated with cardiomegaly and electrocardiographic abnormalities. J Am Med Assoc 181: 1111, 1962.
7. Fisher ER, Puntereri AJ, Jung Y, Korredor DG, Danowski IS - Alcoholism ond other concomitants of mitochondrial inclusions in skeletal muscle. Am J Med Sci 261: 85, 1971.
8. Gilgenkrantz JM, Due ML, Faivre G - Résultats d'une étude systématique de 1' electromyographic dans les myocardiopathies primitives. Arch Mal du Coeur 65: 143, 1972.
9. Haller RG, Knochel JP - Skeletal muscle disease in alcoholism. Med Clin North Am 68: 91, 1984.
10. Hanid A, Slavin G, Mair W, Sowter C, Ward P, Webb J, Levi J - Fibre type changes in striated muscle of alchoolics. J Clin Pathol 34: 991, 1981.
11. Hed R, Larsson H, Wahlgren F - Acute myoglobinuria: report of a case with a fatal outcome. Acta Med Scand 152: 459, 1955.
12. Hughes JT - Toxic myopathies. In Hughes JT: Pathology of Muscle. WB Saunders, Philadelphia, 1974, pg 132-53.
13. Isch F, Stoebner P, Isch-Treussard C, Jesel M, Sengel A, Mauromati-Margat M - Etude electromyographique et histopatologique des muscles squeletiques dans les cardiomyopathies. Rev Electroencephalogr Neurophysiol Clin 5: 411, 1975.
14. Kahn LB, Meyer JS - Acute myopathy in chronic alcoholism: a estudy of 22 autopsy cases with ultrastructural observations. Am J Clin Patho' 53: 516, 1970.
15. Klinkerfuss G, Bleish V, Dioso MM, Perkoff GT - A spectrum of myopathy associated with alcoholism: II. Ligth and electron microscopic observation. Ann Intern Med 67: 493, 1967.
16. Lafair JS, Myerson RM - Alcoholic myopathy with special reference to the significance of creatinophosphokinase. Arch Intern Med 122: 417, 1968.
17. Leoni G - Contributo casistico alla conoscenza delia «miopatia alcoólica». Omnia Med 46: 417, 1968.
18. Lynch PG - Alcoholic myopathy. J Neurol Sci 9: 449, 1969.
19. Lynch PG - Acute cardiomyopathy with rabdomyolysis in chronic alcoholism. Br Med J 1: 44, 1976.
20. Martin FC, Slavin S, Levi AJ - Alcoholic muscle disease. Br Med Bull 38: 53, 1982.
21. Meyer JS - Neurologic complications of alcoholism. Am J Med 46: 118, 1969.
22. Myerson RM, Lafair JS - Alcoholic muscle disease. Med Clin North Am 54: 723, 1970.
23. O'Brien ET, Goddstraw P - Alcoholic myopathy. Br Med J 4: 785, 1969.
24. Oh SJ - Alcoholic myopathy: a critical review. Alab. J Med Sci 9:79, 1972.
25. Pareto RCJr, Couto AA, Freitas LAP, Mendonça J, Materá E, Nahn EPJr, Costa JA, Mesquita ET, Nani E - Miocardiopatia alcoólica: classificação anátomo-funcional pelo ecocardiograma. Arq Bras Med 59: 417, 1985.
26. Perkoff GT - Alcoholic myopathy. Ann Rev Med 22: 125, 1971.
27. Perkoff GT, Dioso MM, Bleisch V, Klinkerfuss G - A spectrum of myopathy associated with alcoholism. I. Clinical and laboratory features. Ann Intern Med 67:481, 1967.
28. Perkoff GT, Hardy P, Velez-Garcia E - Reversible acute muscular syndrome in chronic alcoholism. N Engl J Med 274: 1277, 1966.
29. Pittman J, Decker JW - Acute and chronic myopathy associated with alcoholism. Neurology 21: 293, 1971.
30. Prasad P, Tabatznik B, Kotler MN - Recurrent acute alcoholic myopathy simulating deep vein thrombosis in association with cardiomyopathy and parasystolic ventricular tachicardia. J Hopkins Med J 134: 226, 1974.
31. Regan TJ - Alcoholic cardyomiopathy. Progr Cardiov Dis 28: 141, 1984.
32. Rubin E - Alcoholic myopathy in heart and skeletal muscle. N Engl J Med 301: 28, 1979.
33. Rubin E, Katz AM, Lieber CS, Stein EP, Puszkin S - Muscle damage produced by chronic alcohol consumption. Am J Pathol 83: 499, 1976.
34. Schneider R - Acute alcoholic myopathy with myoglobinuria. South Med J 63: 485, 1970.
35. Seneviratne BIB - Acute cardiomyopathy with rhabdomyolysis in chronic alcoholism. Br Med J 4: 378, 1975.
36. Serratrice G, Toga M, Roux H - Syndromes musculaires proximaux d'évolution chronique survenant chez des ethyliques (à propos de 14 cas). Presse Méd 74: 1721, 1966.
37. Song SK, Rubin E - Ethanol produces muscle damage in human volunteers. Science 175: 327, 1972.
38. Worden RE - Pattern of muscle and nerve pathology in alcoholism. Ann NY Acad Sci 273: 351, 1976.

Associação de miopatia e miocardiopatia alcoólicas: estudo clínico, eletroneuromiográfico e histopatológico do músculo esquelético em 10 casos de miocardiopatia alcoólica

Alcoholic myopathy and cardiomyopathy: clinical, electromyography and muscle biopsy studies of 10 patients with alcoholic cardiomyopathy

Datas de Publicação

Publicação nesta coleção
21 Jun 2011
Data do Fascículo
Dez 1988

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Berk SL, Block PJ, Toselli PA, Ullrick WC - The effects of chronic alcohol ingestion in mice on contractile properties of cardiac and skeletal muscle: a comparision with normal and dehydrated-malnourished controls. Experientia 31: 1302, 1975.

[2] 2. Carlsson C, Dencker SJ, Henriksson KG, Magnussor R, Petersen I, Riman E - Clinical, histological and electromyographical studies in chronic alcoholics. Acta Neurol Scand (supl) 48: 425, 1972.

[3] 3. Curran JR, Wetmore SJ - Alcoholic myopathy. Dis Nerv System 33: 19, 1972.

[4] 4. Dubowitz V, Brooke MH - The procedure of muscle biopsy. In Dubovitz V, Brooke MH - Muscle Biopsy: a Modern Approach. WB Saunders. London, 1973, pg 5-20.

[5] 5. Ekbom K, Hed R, Kirstein L, Astrom KE - Muscular affections in chronic alcoholism. Arch Neurol 10: 449, 1964.

[6] 6. Erlenbron JW, Pilz CG - Paroxismal myoglobinuria associated with cardiomegaly and electrocardiographic abnormalities. J Am Med Assoc 181: 1111, 1962.

[7] 7. Fisher ER, Puntereri AJ, Jung Y, Korredor DG, Danowski IS - Alcoholism ond other concomitants of mitochondrial inclusions in skeletal muscle. Am J Med Sci 261: 85, 1971.

[8] 8. Gilgenkrantz JM, Due ML, Faivre G - Résultats d'une étude systématique de 1' electromyographic dans les myocardiopathies primitives. Arch Mal du Coeur 65: 143, 1972.

[9] 9. Haller RG, Knochel JP - Skeletal muscle disease in alcoholism. Med Clin North Am 68: 91, 1984.

[10] 10. Hanid A, Slavin G, Mair W, Sowter C, Ward P, Webb J, Levi J - Fibre type changes in striated muscle of alchoolics. J Clin Pathol 34: 991, 1981.

[11] 11. Hed R, Larsson H, Wahlgren F - Acute myoglobinuria: report of a case with a fatal outcome. Acta Med Scand 152: 459, 1955.

[12] 12. Hughes JT - Toxic myopathies. In Hughes JT: Pathology of Muscle. WB Saunders, Philadelphia, 1974, pg 132-53.

[13] 13. Isch F, Stoebner P, Isch-Treussard C, Jesel M, Sengel A, Mauromati-Margat M - Etude electromyographique et histopatologique des muscles squeletiques dans les cardiomyopathies. Rev Electroencephalogr Neurophysiol Clin 5: 411, 1975.

[14] 14. Kahn LB, Meyer JS - Acute myopathy in chronic alcoholism: a estudy of 22 autopsy cases with ultrastructural observations. Am J Clin Patho' 53: 516, 1970.

[15] 15. Klinkerfuss G, Bleish V, Dioso MM, Perkoff GT - A spectrum of myopathy associated with alcoholism: II. Ligth and electron microscopic observation. Ann Intern Med 67: 493, 1967.

[16] 16. Lafair JS, Myerson RM - Alcoholic myopathy with special reference to the significance of creatinophosphokinase. Arch Intern Med 122: 417, 1968.

[17] 17. Leoni G - Contributo casistico alla conoscenza delia «miopatia alcoólica». Omnia Med 46: 417, 1968.

[18] 18. Lynch PG - Alcoholic myopathy. J Neurol Sci 9: 449, 1969.

[19] 19. Lynch PG - Acute cardiomyopathy with rabdomyolysis in chronic alcoholism. Br Med J 1: 44, 1976.

[20] 20. Martin FC, Slavin S, Levi AJ - Alcoholic muscle disease. Br Med Bull 38: 53, 1982.

[21] 21. Meyer JS - Neurologic complications of alcoholism. Am J Med 46: 118, 1969.

[22] 22. Myerson RM, Lafair JS - Alcoholic muscle disease. Med Clin North Am 54: 723, 1970.

[23] 23. O'Brien ET, Goddstraw P - Alcoholic myopathy. Br Med J 4: 785, 1969.

[24] 24. Oh SJ - Alcoholic myopathy: a critical review. Alab. J Med Sci 9:79, 1972.

[25] 25. Pareto RCJr, Couto AA, Freitas LAP, Mendonça J, Materá E, Nahn EPJr, Costa JA, Mesquita ET, Nani E - Miocardiopatia alcoólica: classificação anátomo-funcional pelo ecocardiograma. Arq Bras Med 59: 417, 1985.

[26] 26. Perkoff GT - Alcoholic myopathy. Ann Rev Med 22: 125, 1971.

[27] 27. Perkoff GT, Dioso MM, Bleisch V, Klinkerfuss G - A spectrum of myopathy associated with alcoholism. I. Clinical and laboratory features. Ann Intern Med 67:481, 1967.

[28] 28. Perkoff GT, Hardy P, Velez-Garcia E - Reversible acute muscular syndrome in chronic alcoholism. N Engl J Med 274: 1277, 1966.

[29] 29. Pittman J, Decker JW - Acute and chronic myopathy associated with alcoholism. Neurology 21: 293, 1971.

[30] 30. Prasad P, Tabatznik B, Kotler MN - Recurrent acute alcoholic myopathy simulating deep vein thrombosis in association with cardiomyopathy and parasystolic ventricular tachicardia. J Hopkins Med J 134: 226, 1974.

[31] 31. Regan TJ - Alcoholic cardyomiopathy. Progr Cardiov Dis 28: 141, 1984.

[32] 32. Rubin E - Alcoholic myopathy in heart and skeletal muscle. N Engl J Med 301: 28, 1979.

[33] 33. Rubin E, Katz AM, Lieber CS, Stein EP, Puszkin S - Muscle damage produced by chronic alcohol consumption. Am J Pathol 83: 499, 1976.

[34] 34. Schneider R - Acute alcoholic myopathy with myoglobinuria. South Med J 63: 485, 1970.

[35] 35. Seneviratne BIB - Acute cardiomyopathy with rhabdomyolysis in chronic alcoholism. Br Med J 4: 378, 1975.

[36] 36. Serratrice G, Toga M, Roux H - Syndromes musculaires proximaux d'évolution chronique survenant chez des ethyliques (à propos de 14 cas). Presse Méd 74: 1721, 1966.

[37] 37. Song SK, Rubin E - Ethanol produces muscle damage in human volunteers. Science 175: 327, 1972.

[38] 38. Worden RE - Pattern of muscle and nerve pathology in alcoholism. Ann NY Acad Sci 273: 351, 1976.