Alcoholic cardiomyopathy

Definition

Alcoholic cardiomyopathy is a disorder in which excessive, habitual use of alcohol weakens the heart muscle so that it cannot pump blood efficiently.

Alternative Names

Causes

Drinking alcohol in large quantities has a toxic effect on heart muscle cells. Alcoholic cardiomyopathy is a form of dilated cardiomyopathy caused by habitual alcohol abuse.

Alcoholic cardiomyopathy causes the weakened heart muscle to pump inefficiently, leading to heart failure

The disorder is most commonly seen in men ages 35-55 years old, but it may develop in anyone who consumes too much alcohol over a long period of time. Alcoholic cardiomyopathy may be identified as "idiopathic dilated cardiomyopathy," if the person's drinking history is not known.

Symptoms

Symptoms are usually absent until the disease is in an advanced stage. At that point, the symptoms occur due to heart failure and may 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
• Decreased urine output (oliguria)
• Need to urinate at night (nocturia)
• Sensation of feeling the heart beat (palpitations)
• Irregular or rapid pulse

Exams and Tests

A health care provider will conduct a physical examination, which may reveal:

• Abnormal heart sounds
• Abnormal lung sounds
• Murmurs
• Irregular or rapid heartbeat
• Weight gain
• Swollen neck veins
• Enlarged liver
• Ankle swelling
• Low blood pressure

Alcoholic cardiomyopathy is usually diagnosed when chronic heavy drinking is discovered as a cause of the heart failure.

The following tests may reveal signs of heart failure:

• An echocardiogram may show enlarged heart chambers, leaking valves, or reduced pumping efficiency.
• An ECG may show signs of enlarged heart chambers or rhythm abnormalities (arrhythmias).
• A chest x-ray or chest CT may show heart enlargement, fluid accumulation in the lungs and valves, and reduced pumping function.
• A complete routine laboratory study is performed to measure the hormone B-type natriuretic peptide (BNP).
• Cardiac catheterization and coronary angiography may be done to rule out coronary artery blockages as the cause for dilated heart chambers and decreased pumping function.

Treatment

You may be placed on a low-salt diet, and the amount of liquids you drink may be restricted.

Heart failure may be treated with diuretics (furosemide and spironolactone) to remove excessive fluid from your body, and with ACE inhibitors and beta blockers.

In people with congestive heart failure and severely weakened pumping functions, an implantable defibrillator (ICD) may help them live longer. In some cases, a biventricular pacemaker improves symptoms and quality of life. A single device that combines a biventricular pacemaker and an ICD may be recommended.

A heart transplant may be considered when the cardiomyopathy is not reversible.

Eventually, nutritional problems involving thiamine, phosphorus, potassium, or magnesium levels may require treatment.

Support Groups

For more information on support groups where members share common experiences and problems, see alcoholism support groups and heart disease support groups.

Outlook (Prognosis)

Total abstinence from alcohol may stop the disease and improve the heart's functioning, although people with severe heart damage may never return to normal.

Once the heart damage and heart failure is irreversible, the outlook is poor.

Possible Complications

• Congestive heart failure
• Heart arrhythmias, including lethal arrhythmias

When to Contact a Medical Professional

Call your provider if you have any symptoms of heart failure or cardiomyopathy.

Call your provider if alcoholic cardiomyopathy has been diagnosed and symptoms do not improve with treatment.

Go to the emergency room or call 911 if you have alcoholic cardiomyopathy and experience severe chest pain, palpitations, or fainting.

Prevention

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 exercising regularly. Eat a generally well-balanced, nutritious diet, and avoid smoking.