| Alcoholic cardiomyopathy | |
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| Specialty | Cardiology  |
Alcoholic cardiomyopathy (ACM) is a disease in which the long-term consumption of alcohol leads to heart failure. [1] ACM is a type of dilated cardiomyopathy. The heart is unable to pump blood efficiently, leading to heart failure. It can affect other parts of the body if the heart failure is severe. It is most common in males between the ages of 35 and 50.
The causal relationship between alcohol consumption and cardiomyopathy and heart failure is unclear. [2] Per the American Heart Association (AHA), alcohol is one of the leading causes of dilated cardiomyopathy. [2] However, multiple longitudinal studies have shown a paradoxical lowering of dilated cardiomyopathy with modest-to-moderate alcohol consumption. [2]
ACM is a type of heart disease that occurs due to chronic alcohol consumption. The etiology of ACM is multifactorial, with a combination of genetic, environmental, and lifestyle factors playing a role. [2] The direct toxic effects of alcohol on the heart muscle cells (cardiomyocytes) are considered the primary cause of ACM. [2] Chronic alcohol consumption leads to the accumulation of toxic metabolites, such as acetaldehyde and reactive oxygen species, in the heart muscle cells. [2] These toxic substances can cause oxidative stress, inflammation, and damage to the cardiomyocytes, leading to the development of ACM. [3]
Additionally, chronic alcohol consumption can lead to deficiencies in essential vitamins and minerals, such as thiamine, magnesium, and selenium, which are important for the proper functioning of the heart. [4] Thiamine deficiency, in particular, is common in people with alcohol use disorder and can lead to a condition known as beriberi, which can damage the heart muscle. [4] Furthermore, chronic alcohol consumption can also lead to other cardiovascular risk factors, such as high blood pressure, high cholesterol levels, and obesity, which can contribute to the development of ACM. [4] Overall, the etiology of ACM is complex and involves various factors that can damage the heart muscle over time. [4]
Signs and symptoms of alcoholic cardiomyopathy are indistinguishable from those seen in other forms of cardiomyopathy. These symptoms can include the following: [5]
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. In advanced cases, people with ACM may develop severe heart failure, which can cause symptoms such as severe shortness of breath, wheezing, and coughing. [6] If left untreated, ACM can lead to life-threatening complications such as heart failure, arrhythmias, and sudden cardiac death. [6] Therefore, it is important to seek medical attention if any of these symptoms are experienced, especially if there is a history of chronic alcohol consumption.
Alcohol-induced cardiac toxicity (AiCT) is characterized as either acute or chronic. It is believed that consumption of large amounts of alcohol leads to cardiac inflammation, which can be detected by finding large amounts of troponin in the serum. [7] Chronic consumption of alcohol (defined as greater than 80 g per day for at least 5 years) can lead to multi-organ failure, including myocardial dysfunction. [7] The exact pathophysiologic mechanism by which chronic consumption of alcohol causes DCM is not well understood, however it's believed that genetic mutation, and mitochondrial damage due to oxidative stress injury may play a role. [7]
Abnormal heart sounds, murmurs, ECG abnormalities, and enlarged heart on chest x-ray may lead to the diagnosis. Echocardiogram abnormalities and cardiac catheterization or angiogram to rule out coronary artery blockages, along with a history of alcohol abuse can confirm the diagnosis. [4] It's important to note that part of diagnosing Chronic ACM is noting the absence of coronary artery disease. [7] It's also worth noting that the diagnosis of ACM is largely a diagnosis of exclusion.
The diagnosis of alcoholic cardiomyopathy is typically made based on a combination of the patient's medical history, physical examination, and diagnostic tests. [8] Firstly, the doctor will ask the patient about their alcohol consumption habits, as well as any symptoms they may have experienced, such as shortness of breath or swelling in the legs. [8] They may also perform a physical examination to check for signs of heart failure, such as an enlarged heart or fluid buildup in the lungs. [8]
In addition to the patient's medical history and physical exam, the diagnosis of alcoholic cardiomyopathy is often confirmed with various diagnostic tests. [8] One of the most common tests is an echocardiogram, which uses ultrasound waves to create images of the heart and can detect abnormalities in the heart's structure and function. [8] Other tests may include an electrocardiogram (ECG) to measure the heart's electrical activity, and blood tests to check for elevated levels of certain enzymes that may indicate heart damage. [8] If the diagnosis is confirmed, treatment typically involves stopping alcohol consumption and managing heart failure symptoms through medications, lifestyle changes, and in severe cases, heart transplantation. [8]
The prognosis is influenced by several factors, including the amount of alcohol and the time period over which it has been consumed, the presence or absence of dysrhythmias such as atrial fibrillation, and the width of the QRS complex. [9] Some indications of poor prognosis include the following: patients with QRS > 120, patients who continue to consume alcohol for prolonged periods. [9] Consumption of alcohol is directly related to the amount of alcohol consumed and length of consumption. Indicators of good prognosis include the following: successfully quitting the consumption of alcohol (associated with decreased hospital admissions), and patient compliance with beta blockers. [9] Mortality is between 40–80% 10 years post-diagnosis. [9]
The prognosis of alcoholic cardiomyopathy (ACM) varies depending on the severity of the condition, the extent of heart muscle damage, and the response to treatment. Without treatment, ACM can progress to severe heart failure, arrhythmias, and sudden cardiac death. [10] However, with proper treatment, including cessation of alcohol consumption and management of heart failure symptoms, the prognosis can improve significantly. [10]
Research has shown that the mortality rate for people with ACM is higher than that of the general population, with a five-year survival rate of around 50%. [10] However, studies have also shown that people who stop drinking alcohol have a significantly better prognosis than those who continue to drink. In addition, people who receive early treatment for ACM, including medication and lifestyle modifications, have a better chance of improving their heart function and overall health.
The prognosis of ACM can also depend on the presence of other comorbidities such as diabetes, hypertension, and obesity. [10] These conditions can exacerbate the effects of ACM on the heart and increase the risk of complications. [10] Therefore, it is important to manage these comorbidities to improve the overall prognosis of ACM.
There are several complications that can arise as a result of alcoholic cardiomyopathy. For instance, individuals with this condition may be at a higher risk of developing blood clots, which can lead to heart attacks, strokes, or other serious cardiovascular events. [7] Additionally, the weakened heart muscle may not be able to effectively pump blood to the lungs, leading to the accumulation of fluid in the lungs, a condition known as pulmonary edema. [7]
Another potential complication of alcoholic cardiomyopathy is the development of arrhythmias, or abnormal heart rhythms. [7] These irregular heart rhythms can range from mild to severe and may cause symptoms such as palpitations, lightheadedness, or even loss of consciousness. [7] In some cases, arrhythmias can lead to sudden cardiac arrest, a life-threatening condition in which the heart suddenly stops. [7]
Treatment for alcoholic cardiomyopathy involves lifestyle changes, including complete abstinence from alcohol use, a low sodium diet, and fluid restriction, as well as medications. Medications may include ACE inhibitors, beta blockers, and diuretics which are commonly used in other forms of cardiomyopathy to reduce the strain on the heart. Persons with congestive heart failure may be considered for surgical insertion of an ICD or a pacemaker which can improve heart function. In cases where the heart failure is irreversible and worsening, heart transplant may be considered. [7] Treatment will possibly prevent the heart from further deterioration, and the cardiomyopathy is largely reversible if complete abstinence from alcohol is maintained. [7]
Unfortunately, for patients that require heart transplants, cardiomyopathy due to alcoholism has the lowest post-heart transplant survival out of all causes of cardiomyopathy. [11] Per one study that compared 224 alcoholic cardiomyopathy patients to over 60,000 non-alcoholic cardiomyopathy patients, survival post heart transplant was less at 1 year, 5 years, 10 years, and 12 years. [11]
Interestingly, in patients that are defined as "heavy drinkers" (defined as consuming >30g of alcohol/day) decreased alcohol consumption to moderate levels has been shown to be an effective treatment; in fact [12] A retrospective cohort study analyzed data collected from over 3.8 million patients, and categorized patients as either abstinent drinkers, mild drinkers, moderate drinkers, and heavy drinkers. Despite having such a large sample size, the association between alcohol intake and cardiomyopathy remains unclear. [12] The study found that patients that were either mild or moderate drinkers were the least likely to develop HF as compared to patients that were abstinent. [12] The study also found that patients that increased their alcohol consumption from light to moderate and/or from moderate to heavy were at increased risk for heart failure. [12] Although one might think that patients that were completely abstinent from alcohol would have would be least likely of being diagnosed with heart failure, it's actually patients categorized as either light or moderate drinkers had the lowest risk for developing HF. [12]
Cardiology is the study of the heart. Cardiology is a branch of medicine that deals with disorders of the heart and the cardiovascular system. The field includes medical diagnosis and treatment of congenital heart defects, coronary artery disease, heart failure, valvular heart disease, and electrophysiology. Physicians who specialize in this field of medicine are called cardiologists, a sub-specialty of internal medicine. Pediatric cardiologists are pediatricians who specialize in cardiology. Physicians who specialize in cardiac surgery are called cardiothoracic surgeons or cardiac surgeons, a specialty of general surgery.
Cardiomyopathy is a group of primary diseases of the heart muscle. Early on there may be few or no symptoms. As the disease worsens, shortness of breath, feeling tired, and swelling of the legs may occur, due to the onset of heart failure. An irregular heart beat and fainting may occur. Those affected are at an increased risk of sudden cardiac death.
Heart failure (HF), also known as congestive heart failure (CHF), is a syndrome caused by an impairment in the heart's ability to fill with and pump blood.
Alcoholic liver disease (ALD), also called alcohol-related liver disease (ARLD), is a term that encompasses the liver manifestations of alcohol overconsumption, including fatty liver, alcoholic hepatitis, and chronic hepatitis with liver fibrosis or cirrhosis.
Palpitations are perceived abnormalities of the heartbeat characterized by awareness of cardiac muscle contractions in the chest, which is further characterized by the hard, fast and/or irregular beatings of the heart.
Myocarditis is defined as inflammation of the myocardium. Myocarditis can progress to inflammatory cardiomyopathy when there are associated ventricular remodeling and cardiac dysfunction due to chronic inflammation. Symptoms can include shortness of breath, chest pain, decreased ability to exercise, and an irregular heartbeat. The duration of problems can vary from hours to months. Complications may include heart failure due to dilated cardiomyopathy or cardiac arrest.
Arrhythmogenic cardiomyopathy (ACM) is an inherited heart disease.
Hypertrophic cardiomyopathy is a condition in which muscle tissues of the heart become thickened without an obvious cause. The parts of the heart most commonly affected are the interventricular septum and the ventricles. This results in the heart being less able to pump blood effectively and also may cause electrical conduction problems. Specifically, within the bundle branches that conduct impulses through the interventricular septum and into the Purkinje fibers, as these are responsible for the depolarization of contractile cells of both ventricles.
Dilated cardiomyopathy (DCM) is a condition in which the heart becomes enlarged and cannot pump blood effectively. Symptoms vary from none to feeling tired, leg swelling, and shortness of breath. It may also result in chest pain or fainting. Complications can include heart failure, heart valve disease, or an irregular heartbeat.
Alcoholic hepatitis is hepatitis due to excessive intake of alcohol. Patients typically have a history of at least 10 years of heavy alcohol intake, typically 8–10 drinks per day. It is usually found in association with fatty liver, an early stage of alcoholic liver disease, and may contribute to the progression of fibrosis, leading to cirrhosis. Symptoms may present acutely after a large amount of alcoholic intake in a short time period, or after years of excess alcohol intake. Signs and symptoms of alcoholic hepatitis include jaundice, ascites, fatigue and hepatic encephalopathy. Mild cases are self-limiting, but severe cases have a high risk of death. Severity in alcoholic hepatitis is determined several clinical prediction models such as the Maddrey's Discriminant Function and the MELD score.
Peripartum cardiomyopathy (PPCM) is a form of dilated cardiomyopathy that is defined as a deterioration in cardiac function presenting typically between the last month of pregnancy and up to six months postpartum. As with other forms of dilated cardiomyopathy, PPCM involves systolic dysfunction of the heart with a decrease of the left ventricular ejection fraction (EF) with associated congestive heart failure and an increased risk of atrial and ventricular arrhythmias, thromboembolism (blockage of a blood vessel by a blood clot), and even sudden cardiac death. In essence, the heart muscle cannot contract forcefully enough to pump adequate amounts of blood for the needs of the body's vital organs.
Eisenmenger syndrome or Eisenmenger's syndrome is defined as the process in which a long-standing left-to-right cardiac shunt caused by a congenital heart defect causes pulmonary hypertension and eventual reversal of the shunt into a cyanotic right-to-left shunt. Because of the advent of fetal screening with echocardiography early in life, the incidence of heart defects progressing to Eisenmenger syndrome has decreased.
Cardiomegaly is a medical condition in which the heart becomes enlarged. It is more commonly referred to simply as "having an enlarged heart". It is usually the result of underlying conditions that make the heart work harder, such as obesity, heart valve disease, high blood pressure (hypertension), and coronary artery disease. Cardiomyopathy is also associated with cardiomegaly.
Tachycardia-induced cardiomyopathy (TIC) is a disease where prolonged tachycardia or arrhythmia causes an impairment of the myocardium, which can result in heart failure. People with TIC may have symptoms associated with heart failure and/or symptoms related to the tachycardia or arrhythmia. Though atrial fibrillation is the most common cause of TIC, several tachycardias and arrhythmias have been associated with the disease.
Loeffler endocarditis is a form of heart disease characterized by a stiffened, poorly-functioning heart caused by infiltration of the heart by white blood cells known as eosinophils. Restrictive cardiomyopathy is a disease of the heart muscle which results in impaired diastolic filling of the heart ventricles, i.e. the large heart chambers which pump blood into the pulmonary or systemic circulation. Diastole is the part of the cardiac contraction-relaxation cycle in which the heart fills with venous blood after the emptying done during its previous systole.
Right ventricular hypertrophy (RVH) is a condition defined by an abnormal enlargement of the cardiac muscle surrounding the right ventricle. The right ventricle is one of the four chambers of the heart. It is located towards the right lower chamber of the heart and it receives Deoxygenated blood from the right upper chamber and pumps blood into the lungs.
Takotsubo cardiomyopathy or takotsubo syndrome (TTS), also known as stress cardiomyopathy, is a type of non-ischemic cardiomyopathy in which there is a sudden temporary weakening of the muscular portion of the heart. It usually appears after a significant stressor, either physical or emotional; when caused by the latter, the condition is sometimes called broken heart syndrome.
Cardiac amyloidosis is a subcategory of amyloidosis where there is depositing of the protein amyloid in the cardiac muscle and surrounding tissues. Amyloid, a misfolded and insoluble protein, can become a deposit in the heart's atria, valves, or ventricles. These deposits can cause thickening of different sections of the heart, leading to decreased cardiac function. The overall decrease in cardiac function leads to a plethora of symptoms. This multisystem disease was often misdiagnosed, with a corrected analysis only during autopsy. Advancements of technologies have increased earlier accuracy of diagnosis. Cardiac amyloidosis has multiple sub-types including light chain, familial, and senile. One of the most studied types is light chain cardiac amyloidosis. Prognosis depends on the extent of the deposits in the body and the type of amyloidosis. New treatment methods are actively being researched in regards to the treatment of heart failure and specific cardiac amyloidosis problems.
Amyloid light-chain (AL) amyloidosis, also known as primary amyloidosis, is the most common form of systemic amyloidosis. The disease is caused when a person's antibody-producing cells do not function properly and produce abnormal protein fibers made of components of antibodies called light chains. These light chains come together to form amyloid deposits which can cause serious damage to different organs. An abnormal light chain in urine is known as Bence Jones protein.
Management of heart failure requires a multimodal approach. It involves a combination of lifestyle modifications, medications, and possibly the use of devices or surgery.
