Alcoholic Cardiomyopathy: Causes, Symptoms, and Diagnosis

Acute AIC can occur following the consumption of a large volume of alcohol. This can cause heart inflammation, leading to an atypically fast heart rhythm, such as atrial fibrillation (AF). Without an adequate supply of blood and oxygen, the body’s organs and tissues can no longer function properly. This can result in various symptoms, including fluid retention and episodes. If the heart weakens, as it can with heart failure, it begins to enlarge. This forces the heart to work harder to pump blood to the rest of the body.

• So Hildegard von Bingen (1098–1179), one of the most prominent mysticians of her time, recommended her heart wine as a universal remedy.
• If enough scar tissue develops, the liver cannot work properly, and the person is in serious danger.

Chronic alcohol use often leads to poor nutrition and vitamin deficiencies. Inadequate nutrition can contribute to heart muscle damage and worsen the progression of alcoholic cardiomyopathy. The continuous loss of heart muscle cells along with the inflammatory responses and oxidative stress can potentially lead to enlargement of the heart chambers, particularly the left ventricle.

Treatment Options for ACM

These changes, though subtle, were similar to those found by Ferrans and Hibbs in eight deceased individuals diagnosed with ACM[42,43]. On histological examination, various degrees of fibrosis, patchy areas of endocardial fibroelastosis, intramural blood clots and focal collections of swollen cells in both the epicardium and endocardium were found. Also, there were significant size variations in the myofibrils and they showed a relative decrease in the number of striations, in addition to swelling, vacuolisation and hyalinisation.

• As with most forms of disease, a healthy lifestyle—including a proper diet, exercise, minimal stress, and low or moderate levels of alcohol consumption or abstinence—can work to promote healing.
• Abnormal heart sounds, murmurs, ECG abnormalities, and enlarged heart on chest x-ray may lead to the diagnosis.
• Once free from alcohol, substance abuse treatment and medical treatments for alcoholic cardiomyopathy can begin.

Future studies with a strict classification of non-drinkers and drinkers will help clarify whether complete abstinence is mandatory for ACM patients. In the interim it seems appropriate to continue discouraging any alcohol consumption in these patients, as it would be difficult for them to maintain a limited alcohol intake considering their history of alcohol dependence and abuse. Myocardial impairment following chronic excessive alcohol intake has been evaluated using echocardiographic and haemodynamic measurements in a significant number of reports. In these studies, haemodynamic and echocardiographic parameters were measured in individuals starting an alcohol withdrawal program. The findings were analysed taking into account the amount and chronicity of intake and they were compared with the same parameters measured in a control group of non-drinkers. Unfortunately Lazarević et al[23], as in most of these studies, systematically excluded patients with a history of heart disease or with HF symptoms.

Acute reversible left ventricular dysfunction secondary to alcohol

The natural history and long-term prognosis studies of Gavazzi et al[10] and Fauchier et al[11] compared the evolution of ACM patients according to their degree of withdrawal. These authors found a relationship between the reduction or cessation of alcohol consumption and higher survival rates without a heart transplant. Clinical observation confirmed that several days to weeks of drinking show higher and weeks of abstinence lower pressures. Alcohol intake may also interfere with the drug and dietary treatment of hypertension. This altogether supports a causal relationship between alcohol consumption and a hypertensive state.

Ballester specifically analysed the effects of alcohol withdrawal on the myocardium using antimyosin antibodies labelled with Indium-111[72]. This radiotracer has been acknowledged as an indicator of irreversible myocardial damage. Of the 56 patients included in the study, 28 were former drinkers and 28 continued consuming alcohol during the study. Absorption levels of Indium-111 were high in 75% of patients who continued drinking and in only 32% of those who had withdrawn from consuming alcohol. Alterations caused by heavy alcohol intake have also been studied from the perspective of histopathology. Emmanuel Rubin analysed muscle biopsies from individuals who were previously non-drinkers and were submitted to a balanced diet with heavy alcohol intake during one month[41].

Imaging Tests

It is therefore possible that patients with ACM could also harbour a genetic substrate that predisposes them to this form of cardiomyopathy. This review revisits our past and deals with our current thinking on the epidemiology, pathophysiology, clinical characteristics, and treatments available for alcoholic cardiomyopathy. At the cardiology appointment, an exam alcoholic cardiomyopathy will include a simple pulse and blood pressure (hypertension) check, in addition to listening to the heart and lungs for abnormalities. Your doctor might prescribe ACE inhibitors and beta-blockers to help lower your blood pressure. If your heart is severely damaged, your doctor may recommend an implantable defibrillator or pacemaker to help your heart work.

• In 1893, Graham Steell, well known for the Graham Steell murmur due to pulmonary regurgitation in pulmonary hypertension or in mitral stenosis, reported 25 cases in whom he recognized alcoholism as one of the causes of muscle failure of the heart.
• In patients exhibiting chronic alcohol use, other causes of dilated cardiomyopathy need workup.
• Addiction Resource aims to provide only the most current, accurate information in regards to addiction and addiction treatment, which means we only reference the most credible sources available.
• Alcohol addiction treatment often begins with medically assisted detox, which rids the body of alcohol.
• From the data provided in the available ACM studies, it appears that patients who received an ACEI globally showed improved prognosis.

Since it’s minimally invasive, it involves less recovery time and fewer complications than a septal myectomy. The primary treatment for ACM involves complete abstinence from alcohol or other drugs. However, some studies show that moderating alcohol consumption may lead to similar health outcomes. The heart’s LV attempts to compensate for this damage by enlarging to achieve a higher blood output. However, as the LV enlarges, its muscular walls begin to thin and weaken.

How to Diagnose ACM

Ask your provider when you can return to light activity, work and exercise. Most people are able to return to usual activity within one week of the procedure. Alcohol septal ablation is a commonly used procedure to treat hypertrophic cardiomyopathy — the most common type of inherited heart disease. Healthcare providers believe about 1 of every 500 people has the condition. Alcohol septal ablation (ASA) is a minimally invasive, nonsurgical treatment for hypertrophic cardiomyopathy. For this procedure, providers use a catheter (long, thin tube) to inject alcohol in the heart’s artery.

Various pathophysiological mechanisms have been postulated in the development of cardiomyopathy however one key factor undergoing active research is the role of genetic mutation and susceptibility to develop cardiomyopathy. Assessment and treatment of arrhythmia in patients who are heavy users of alcohol can be challenging if abstinence, or at least a significant reduction in intake, is not achieved 38. Specifically, for atrial fibrillation, anticoagulation to reduce risk of stroke and ventricular rate control are central to the management strategy. In some cases, direct current cardioversion or electrophysiologically guided ablation techniques may be used, but ablation is known to be less successful in those who continue to drink alcohol, with higher AF relapse rates 39. Heavy alcohol use over time increases the risk of an alcohol use disorder, as does starting at a young age. A family history of alcohol abuse can raise the chance someone will become addicted, due to genetic and environmental factors.

Atrial fibrillation and supraventricular tachyarrhythmias are common findings in 15–20 % of patients [111], whereas ventricular tachycardias are rare [112]. On ECG, unspecific abnormalities like complete or incomplete left bundle branch block, atrioventricular conduction disturbances, alterations in the ST segment, and P wave changes can be found comparable to those in idiopathic DCM [113]. The signs and symptoms of alcoholic cardiomyopathy (ACM) can vary depending on the severity of the condition.[6] In the early stages, people with ACM may not experience any symptoms. However, as the condition progresses, they may experience symptoms such as fatigue, shortness of breath, palpitations, and swelling of the legs and ankles.[6] They may also experience chest pain, dizziness, and fainting. In some cases, ACM can cause arrhythmias or irregular heartbeats, which can be life-threatening.