Here's How Alcohol Withdrawal Can Lead to Heart Failure


True Blood star Nelsan Ellis struggled with drug and alcohol abuse for years before his untimely death, according to a statement released Monday by the actor's manager, on behalf of his family. Ellis, who played fan favorite Lafayette on the HBO series, died of heart failure on July 8, at age 39.

"After many stints in rehab, Nelsan attempted to withdraw from alcohol on his own," wrote Ellis' manager, Emily Gerson Saines, in the statement. "[D]uring his withdrawal from alcohol he had a blood infection, his kidneys shut down, his liver was swollen, his blood pressure plummeted, and his dear sweet heart raced out of control."

Until there is a toxicology report, we can't know for sure whether there was a link between Ellis' substance abuse and his heart failure. But there's no question that withdrawal from alcohol or drugs can wreak havoc on the body's organs, especially the liver and heart, says Linda Richter, PhD, director of policy research and analysis at The National Center on Addiction and Substance Abuse in New York City.

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"Prolonged alcohol use weakens the heart muscle and makes it less able to pump blood efficiently," she explained in an email to Health. "The lack of adequate blood flow interferes with the proper functioning of all of the body’s organs, and can lead to heart failure and other potentially fatal health conditions."

Heart failure is a chronic condition in which the heart becomes enlarged and struggles to pump enough blood to meet the body's needs.

A study published in 2014 in the Journal of the American College of Cardiology suggests that even moderate drinking may raise a person's risk of heart problems. The researchers followed more than 79,000 adults for up to 12 years and found that those who drank one to three drinks per day were more likely to develop atrial fibrillation, an irregular heartbeat that can lead to heart failure, as well as blood clots, stroke, and other heart-related complications.

"The brain adapts [to alcohol] by releasing chemicals with the opposite effect," or natural stimulants, says Richter. If someone has developed a dependency to alcohol and you suddenly remove it from their system, those chemicals can overstimulate the brain and body. "This can result in dramatic changes in how the brain controls circulation (blood pressure and heart rate) and breathing, increasing the risk of heart attacks, strokes, and death."

That's why it's so dangerous for alcoholics to quit cold turkey, says Edwin Salsitz, MD, an assistant clinical professor of psychiatry at the Icahn School of Medicine at Mount Sinai in New York City. Alcohol withdrawal syndrome—which can include seizures, bouts of disorientation, and severe anxiety—has a 5% to 10% mortality rate.

Experts recommend that people with substance abuse problems enter a treatment program, either in a hospital or community-based setting, where they can taper their use of alcohol or drugs under medical supervision. "There is a protocol and medicine is often used to regulate blood pressure and heart rate, keep seizure activity at a minimum, and deal with some of the physical misery they’re going to go through," says Gerard Schmidt, president of the Association for Addiction Professionals, who is based in Morgantown, West Virginia.

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But rehab isn't always successful, of course. Many people like Ellis go through multiple programs without a successful long-term solution. A sense of pride or shame may drive someone to try to quit on their own, adds Schmidt.

In Ellis' case, Dr. Salsitz (who never treated the actor) said he would be surprised if alcohol withdrawal alone led to heart failure in a man so young. "For someone his age, alcohol wouldn't typically cause heart failure," he says. "We won't know until the toxicology report is released."