What is Alcoholic Cardiomyopathy (Alcohol-related Heart Damage)?
Alcohol-induced toxicity can lead to a condition called non-ischemic dilated cardiomyopathy, which is when the heart muscles expand and lose their ability to contract properly. These symptoms often occur in people who have a history of heavy alcohol use and do not have any other form of heart disease that might explain their symptoms, such as coronary artery disease.
Alcohol use is a significant reason for non-ischemic cardiomyopathy, contributing to 10% of all cases of dilated heart muscle diseases.
Chronic alcohol abuse is the main risk factor for developing this condition. However, there isn’t a specific limit set on how much alcohol consumption could lead to this disease.
What Causes Alcoholic Cardiomyopathy (Alcohol-related Heart Damage)?
Alcohol and the substances it changes into inside the body can harm the heart. At first, the heart’s ability to pump blood effectively can decrease because of alcohol, but this can get better if a person stops drinking. However, with continued, heavy drinking, this heart damage can become permanent.
There isn’t a set amount of time or alcohol consumption that will definitely cause a particular type of heart disease known as dilated cardiomyopathy. But, daily drinking of around 80 grams of alcohol or more for over 5 years can significantly increase the risk. Despite this, not everyone who drinks heavily and regularly will develop this alcohol-induced heart condition.
Similarly, no specific amount of alcohol is known to be directly toxic to heart cells, and no period of exposure has been identified to definitely cause Alcohol-induced cardiomyopathy. But again, heavy drinking of 80 grams per day for at least 5 years greatly increases the risk, although not all heavy drinkers will develop the condition.
In a long-term study of 2368 adults, drinking habits and heart health were examined over time. The study found that as alcohol intake increased, the health of the ventricles, the heart’s main pumping chambers, got worse. Heavy drinkers had larger left ventricles and a higher volume of blood when the heart was relaxed and dilated after 20 years. However, alcohol consumption didn’t appear to have any significant effect on the ability of the heart to pump blood.
Risk Factors and Frequency for Alcoholic Cardiomyopathy (Alcohol-related Heart Damage)
Alcoholic cardiomyopathy, a heart condition caused by heavy drinking, is a major reason behind non-ischemic dilated cardiomyopathy in the United States. This disease is prevalent among heavy drinkers, with 1-2% of heavy alcohol users diagnosed with it. Approximately 21-36% of all non-ischemic cardiomyopathies are due to alcohol use. However, there is not enough data going into more depth about the impact of alcohol-induced cardiomyopathy.
This condition is most often seen in men aged 30 to 55 who have a significant history of alcohol use of over 10 years. Women make up about 14% of all alcoholic cardiomyopathy cases. It’s worth noting though, that women need less lifetime exposure to alcohol than men to develop this condition.
The condition’s death rates are higher in males than in females and are more prevalent among black individuals compared to the white population. Other factors, like genetics, exposure to heart-damaging substances, or deficiencies in essential minerals like thiamine, also impact the rate at which alcoholic cardiomyopathy progresses.
- Alcoholic cardiomyopathy is a heart disease predominantly seen in the US caused by heavy drinking.
- It occurs in 1-2% of all heavy alcohol users.
- 21-36% of all non-ischemic cardiomyopathies are due to alcohol use.
- This illness most commonly affects men aged 30-55 who have been drinking heavily for over 10 years.
- Women make up about 14% of all cases but need less alcohol exposure to develop the condition.
- Death rates are higher among males and black individuals.
- Progression of alcoholic cardiomyopathy can be influenced by factors such as genetics, exposure to other heart-damaging substances, and deficiencies in minerals like thiamine.
Signs and Symptoms of Alcoholic Cardiomyopathy (Alcohol-related Heart Damage)
Alcoholic cardiomyopathy is a heart disease that can cause signs and symptoms similar to congestive heart failure. It often appears in people who have abused alcohol for a long time. On one hand, it can lead to a condition where the heart becomes enlarged, making it difficult to pump blood effectively. Symptoms may gradually worsen and include shortness of breath, difficulty breathing when lying flat or at night, feeling of missed heartbeats, or fainting episodes which may happen due to rapid heart rhythms associated with this disease.
On the other hand, the earliest sign of this disease can be a type of heart dysfunction where the heart can’t fill properly with blood which is often observed in about 30% of those with chronic alcohol abuse.
If we examine these patients physically, they may show general signs of heart failure such as:
- Lack of appetite
- Generalized weight loss
- Muscle wasting
- Weakness
- Swelling in the legs and ankles
- Fluid accumulation in the belly
- Enlarged liver
- Neck veins that stand out
The heart may also have rapid rhythms, and the point where the heartbeat can be felt may be lower and farther to the left than normal. A specific kind of abnormal heart sound and a murmur due to leakage in the heart’s mitral valve may be heard.
People with chronic alcohol abuse may also have other conditions associated with it. For example, they may show signs of liver disease, folate deficiency, have an increased risk of bleeding, be malnourished, suffer from sunken eyes due to fat pad loss, have damage to their peripheral nerves, and even have neurological conditions like Wernicke-Korsakoff syndrome causing confusion and memory loss.
Testing for Alcoholic Cardiomyopathy (Alcohol-related Heart Damage)
Diagnosing alcoholic cardiomyopathy is not easy. Doctors look for a history of heavy drinking and rule out other causes. Tests like MCV, GGT, AST, ALT, and INR can help support the diagnosis by showing liver damage. Other tests like ECG and chest x-ray can show irregular heartbeats, heart damage, and fluid buildup. Alcoholic cardiomyopathy is confirmed with an echocardiogram, which shows a larger-than-normal heart and reduced ability to pump blood. Heart scans and coronary angiograms are also done to rule out other causes.
Treatment Options for Alcoholic Cardiomyopathy (Alcohol-related Heart Damage)
The best way to treat alcoholic cardiomyopathy, a heart condition resulting from heavy drinking, is to completely stop consuming alcohol. Patients should be offered resources and counseling to aid their sobriety.
If the disease has led to secondary heart failure, additional treatment will be needed to manage symptoms and related complications.
There’s some debate in the medical community regarding moderate alcohol consumption. Some studies suggest that drinking alcohol in moderate amounts could lead to the same health outcomes as total abstinence.
In terms of medication, the treatment for this condition often involves a regimen similar to the one used for idiopathic dilated cardiomyopathy, a type of heart disease. This usually combines several types of drugs, such as beta-blockers, ACE inhibitors, diuretics, aldosterone receptor antagonists, and Angiotensin receptor-neprilysin inhibitors (if the left ventricular ejection fraction is 40% or less). Certain medications like carvedilol and trimetazidine, combined with standard heart failure drugs, have shown beneficial effects in some studies.
New, promising treatments are in the works. They target specific processes that contribute to the development of alcoholic cardiomyopathy. These include myocyte hypertrophy (abnormal enlargement of heart cells), cell death, fibrosis (the formation of excess fibrous connective tissue), and oxidative stress. However, these promising treatments are still being researched and aren’t available yet.
What else can Alcoholic Cardiomyopathy (Alcohol-related Heart Damage) be?
Here are some heart conditions that may present similar symptoms to one another. It’s important for doctors to carefully consider these when making a diagnosis:
- Constrictive heart muscle disease
- Thickened heart muscle disease
- Swelling heart with no known cause
- Heart muscle disease due to liver cirrhosis
- Heart muscle disease due to extreme emotional or physical stress
- Heart muscle disease caused by medication
- Beriberi – a deficiency of thiamine (vitamin B1)
What to expect with Alcoholic Cardiomyopathy (Alcohol-related Heart Damage)
The length of time and how much you drink are two factors that directly influence your long-term survival.
Alcohol-induced heart enlargement (known as dilated cardiomyopathy) usually has a better survival outlook than heart enlargement caused by restricted blood flow (ischemia-induced cardiomyopathy). Some conditions that can worsen outcomes include heart rhythm issue known as atrial fibrillation, a prolonged QRS waveform on a heart monitor, and not taking medication called beta-blockers.
Patients who continue to drink alcohol tend to have worse outcomes. However, studies suggest that people who successfully stop drinking tend to have better overall health outcomes. They usually have fewer hospital admissions and improvements in heart size as seen on a type of heart scan known as an echocardiogram.
If you continue to drink alcohol, you risk complications like worsening heart failure, irregular heartbeat, and clots travelling in the bloodstream (cardioembolic phenomenon). Data shows that, depending on the amount of alcohol consumed, 40-80% of drinkers could die within 10 years.
Possible Complications When Diagnosed with Alcoholic Cardiomyopathy (Alcohol-related Heart Damage)
Common Complications:
- Heart failure
- Extreme weight loss and muscle wasting (Cachexia)
- Abnormal heart rhythms (Arrhythmias)
- Blockage of a blood vessel by a clot that has broken off from another site in the bloodstream (Cardioembolism)
- Death
