Alcoholic cardiomyopathy: Treatments, outlook, and more

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. As early as in 1915, Lian [45] reported in middle-aged French servicemen during the first world war that heavy drinking could lead to hypertension. It took almost 60 years before further attention was paid to the complex interaction between the heart and the peripheral vasculature in various cross-sectional and prospective epidemiologic studies, which have empirically confirmed this early report.

  • This article will explain how heavy drinking can affect the heart and lead to other complications.
  • The prevalance of alcoholic cardiomyopathy in addiction units is estimated around %.
  • For example, some people who are on cholesterol-lowering medicines may experience muscle aches when they drink alcohol.
  • This test will assess the ejection fraction (EF), a measurement that expresses how much blood the LV pumps out with each contraction.
  • While there wasn’t much of a difference in risk between younger and older groups who drank moderately, younger people in the study had greater mortality risks than the older ones at high consumption levels.

Moreover, myofibrils showed a progressively distorted structure, resulting in a homogeneous mass. Unfortunately Lazarević et al[23], as in most of these studies, systematically excluded patients with a history of heart disease or with HF symptoms. It is therefore possible that most of these studies may have also consistently omitted most alcohol abusers in whom alcohol had already caused significant ventricular dysfunction. Although the severity of histological alterations on endomyocardial biopsy correlates with the degree of heart failure in one of our studies, biopsy is not in common use for prognostic purposes [117]. Even the recovery after abstinence of alcohol is hard to predict based on morphometric evaluation of endomyocardial biopsies [118].

Prolonged drinking can cause alcoholic cardiomyopathy

Death might also be sudden due to arrhythmias, heart conduction block, and systemic or pulmonary embolism. In these patients, only early and absolute abstinence of alcohol can reverse myocardial dysfunction [56, 57, 126] which in a historic study by McDonald and Burch was achieved with prolonged bedrest for several months without further access to alcoholic beverages. This was an excellent result long before ACE inhibitors or betablockers were available for heart failure treatment [57]. The associations between drinking and CV diseases such as hypertension, coronary heart disease, stroke, peripheral arterial disease, and cardiomyopathy have been studied extensively and are outlined in this review.

The proportion of cardiomyopathy cases attributable to alcohol abuse has ranged from 23 to 40 percent (Piano and Phillips 2014). Recently, Guzzo-Merello and colleagues (2015) reported that, among 282 patients with a dilated cardiomyopathy phenotype, 33 percent had ACM. However, some reports indicate that alcohol-dependent women develop ACM after consuming less alcohol over a shorter period than do age-matched alcohol-dependent men (Fernández-Solà et al. 1997; Urbano-Marquez et al. 1989). The acute effects of alcohol on the myocardium include a weakening of the heart’s ability to contract (negative inotropic effect).

Alcohol use disorder and cardiomyopathy

In addition, it provides information not only on overall heart size and function, but on valvular structure and function, wall motion and thickness, and pericardial disease. This study included 321 patients with ACM admitted to our hospital between 2003 and 2013. All-cause mortality was assessed using Kaplan–Meier survival curves, and the risk factors were assessed using Cox regression. A receiver operating characteristic (ROC) curve analysis was performed to optimize the cutoff point for discriminating between the 2 risk groups. The suspicion that there may be an individual susceptibility to this disease is underscored by the finding that only a small group of alcoholics develop ACM, and that a proportional relationship between myocardial damage and alcohol intake has not been proven.

  • However, among studies designed to examine the influence of beverage type, no differences have been found in CV disease outcomes or biologic markers, such as HDL-c (Mukamal et al. 2003a; Volcik et al. 2008).
  • Alcoholic cardiomyopathy is best managed with an interprofessional approach with the involvement of primary care physician and cardiology.
  • It’s also important to know that the ways in which alcohol affects your heart will vary from person to person, depending on your age and other conditions you may have.

Ask any patient presenting with new heart failure of unclear etiology about their alcohol history, with attention to daily, maximal, and lifetime intake and the duration of that intake. Moderate drinking — one drink a day for women and two for men — appears to protect some people against heart disease. 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. Elevations in troponin can signify heart damage or an increase in cardiac output that results in demand ischemia.

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Certain microscopic features may suggest damage secondary to alcohol causing cardiomyopathy. Commonly seen cellular structural alterations include changes in the mitochondrial reticulum, cluster formation of mitochondria and disappearance of inter-mitochondrial junctions. Cardiac MRI may be helpful in the differential diagnosis to hypertrophic cardiomyopathy, storage diseases, and inflammatory cardiomyopathy.

alcoholic cardiomyopathy how much drinking

If you’re not sure, make a note to tune into how much you’re having over the course of the next month or so. If it’s more than recommended, try to consciously pace your drinking to help reduce the spike in your blood pressure that excessive alcohol causes. But heavy drinking can affect how well the liver can make proteins that help control blood clotting.

A doctor can guide someone to resources to help them quit drinking and can make referrals. The NIAAA provides an Alcohol Treatment Navigator, where people can learn about AUD treatments and access care and support networks locally. According to the NIAAA, many people with AUD recover, although setbacks are common among those receiving treatment. Individuals who completely quit alcohol generally have improved overall outcomes. They typically require fewer hospitalizations and show improved heart function on ECG readings. This can cause heart inflammation, leading to an atypically fast heart rhythm, such as atrial fibrillation (AF).

The authors examined the prevalence of cardiomegaly by means of chest x-rays and related it to alcohol consumption among a consecutive series of Japanese males of working age. They found that 2 of the 6 individuals (33%) whose alcohol alcoholic cardiomyopathy consumption exceeded 125 mL/d had cardiomegaly. In contrast, an enlarged heart was found in only 1 of 25 subjects with moderate consumption (4%), in 6 of 105 very mild consumers (5.7%), and in 4.5% of non-drinking individuals.