Alcoholic cardiomyopathy is a disorder in which excessive, habitual use of alcohol weakens the heart muscle. The heart cannot pump blood efficiently, and this in turn affects the lungs, liver, brain, and other body systems.
Causes, incidence, and risk factors
Drinking alcohol in excessive quantities has a directly toxic effect on heart muscle cells. Alcoholic cardiomyopathy is a form of dilated cardiomyopathy caused by habitual alcohol abuse.
Alcoholic cardiomyopathy causes poor heart function because the heart muscle becomes too weak to pump efficiently. The condition leads to heart failure. Lack of blood flow affects all parts of the body, resulting in damage to multiple tissues and organ systems.
The disorder is most commonly seen in males ages 35 to 55 years old, but it may may develop in anyone who consumes too much alcohol over a long period of time. Alcoholic cardiomyopathy may be indistinguishable from idiopathic dilated cardiomyopathy if the history of drinking is not known.
Symptoms are usually absent until the disease is in an advanced stage. At that point, the symptoms occur because of heart failure. Patients also often show muscular weakness because of a direct alcohol effect on muscles (alcoholic myopathy).
Possible symptoms include:
- Ankle, feet, and leg swelling
- Overall swelling
- Loss of appetite
- Shortness of breath, especially with activity
- Breathing difficulty while lying down
- Fatigue, weakness, faintness
- Decreased alertness or concentration
- Cough containing mucus, or pink, frothy material coughed up
- Decreased urine output (oliguria)
- Need to urinate at night (nocturia)
- Sensation of feeling the heart beat (palpitations)
- Pulse may feel irregular or rapid
Signs and tests
The examination and tests are directed at diagnosing and evaluating heart failure . Alcoholic cardiomyopathy is usually diagnosed when chronic heavy drinking is discovered as a cause of the heart failure.
Alcoholic patients often also have vitamin deficiencies, especially thiamin deficiency. (The more severe form of this deficiency is beriberi.) Thiamin deficiency also causes alcoholic brain damage (Korsakoff’s syndrome, Wernicke-Korsakoff syndrome).
The physical examination may reveal an irregular or rapid heartbeat. There may be distended neck veins, enlarged liver, swelling of the arms and legs, and signs of pleural effusion (fluid around the lungs). Listening to the chest with a stethoscope may reveal lung crackles or abnormal heart sounds. Blood pressure may be low or may drop when the patient stands.
Heart failure may show on these tests:
- Chest X-ray
- Chest CT
- A cardiac catheterization and coronary angiography
- An ECG may show heart enlargement or arrhythmias.
- A myocardial biopsy may be helpful to distinguish alcoholic cardiomyopathy from other diseases that may cause cardiomyopathy
- CPK test
The goal of treatment is management of heart failure. Hospitalization may be required until acute symptoms subside. The most important aspect of therapy is for the patient to stop drinking alchohol, which leads to an improvement in heart function. Continued alcohol consumption, on the other hand, will continue to worsen heart function.
Treatment for heart failure may include medications to improve heart function, such as diuretics (e.g., furosemide) to remove excessive fluid from the body, and ACE inhibitiors and beta blockers, which have been shown to save lives in heart failure patients.
A low-salt diet may be recommended in some cases. Drinking fluids may be restricted. A heart transplant may be considered. Associated nutritional deficiencies (e.g., thiamin deficiency) and abnormalities in phosphorus, potassium or magnesium levels may require treatment.
For more information on support groups where members share common experiences and problems, see alcoholism support groups and heart disease support groups.
The outcome is variable. Some affected individuals remain stable for long periods, some deteriorate gradually, and some deteriorate rapidly.
- congestive heart failure
- cardiac arrhythmias, including lethal arrhythmias
Calling your health care provider
Call your health care provider if symptoms of heart failure or cardiomyopathy develop.
Call your health care provider if alcoholic cardiomyopathy has been diagnosed and symptoms do not improve with treatment.
Go to the emergency room or call the local emergency number (such as 911) if severe chest pain, palpitations, or fainting occur in a person with alcoholic cardiomyopathy.
Alcoholic cardiomyopathy is a consequence of years of excessive alcohol use. Do not use alcohol in excess. If you drink heavily and find that you cannot cut down or stop drinking, seek help.
Control other risk factors for heart disease by maintaining a healthy weight and excercising regularly. Eat a generally well-balanced, nutritious diet and avoid or minimize smoking.
by Armen E. Martirosyan, M.D.