In our patient, myocardial biopsy was contemplated, but given the rapid recovery of ventricular function, its diagnostic limitations and the absence of its clinical implications, the risk of this procedure outweighed its benefits, and thus, it alcoholic cardiomyopathy symptoms was not performed. However, given the characteristic rise and fall of cardiac enzyme levels, this supports the diagnosis of acute alcohol-induced myocardial damage. In our patient, acute myocardial injury and cardiomyopathy improved significantly with abstinence from alcohol. The patient’s delirium tremens was treated with benzodiazepines, and her congestive heart failure was treated with diuretics and an angiotensin-converting enzyme (ACE) inhibitor. The pancytopenia and elevated liver enzyme levels resolved within a few days of hospital admission, with abstinence from alcohol.
- The pulmonary or respiratory system includes the lungs, diaphragm, and trachea.
- Individuals with certain mitochondrial deoxyribonucleic acid (DNA) mutations and angiotensin-converting enzyme (ACE) genotypes (DD genotype) may be particularly susceptible to the damaging effects of alcohol.
- 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.
- The relationship of alcohol with heart disease or dementia is complicated by the fact that moderate alcohol consumption was shown not only to be detrimental but to a certain degree also protective against cardiovascular disease 14 or to cognitive function in predementia.
Acute reversible left ventricular dysfunction secondary to alcohol
- If so, sometimes it’s a true heart attack, meaning a blocked coronary artery.
- Atrial fibrillation and supraventricular tachyarrhythmias are common findings in 15–20 % of patients 111, whereas ventricular tachycardias are rare 112.
- In some cases, ACM can cause arrhythmias or irregular heartbeats, which can be life-threatening.
- The symptoms of left ventricular diastolic function included waking up at night with shortness of breath, irregular heartbeat, extreme fatigue and weakness, dizziness and fainting, bouts of chest pain, and swelling in the feet, ankles, and abdomen 13.
Furthermore, in many of these reports, comorbid conditions, especially myocarditis and other addictions such as cocaine and nicotine, were not reported. 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.
Cardiac Effects of 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 month41. These changes, though subtle, were similar to those found by Ferrans and Hibbs in eight deceased individuals diagnosed with ACM42,43. 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.
- Biomarkers of heart failure such as NT-proBNP and of myocardial necrosis such as the troponins and CKMB indicate heart failure or myocytolysis.
- The pancytopenia and elevated liver enzyme levels resolved within a few days of hospital admission, with abstinence from alcohol.
- As pointed out before, the current accepted definition of ACM probably underestimates the number of women affected by the disease.
- 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.
Patient education
It should be noted that a moderate drinker included in this latter group showed an improvement of his ejection fraction. Before this medical admission, the patient had two previous admissions for acute pancreatitis due to ethanol abuse. On both occasions, she had normal cardiac enzyme levels and no evidence of cardiac dysfunction, and a chest x-ray revealed no cardiomegaly or pulmonary edema. Her most recent admission with pancreatitis had occurred four months before the present admission. The mainstay of therapy for alcoholic cardiomyopathy (AC) is to treat the underlying cause, ie, to have the patient exercise complete and perpetual abstinence from all alcohol consumption.
- Based on these data, acute ethanol-induced injury appears to be mediated by ethanol and acetaldehyde; the latter may play a more important role.
- Next, we established inclusion and exclusion criteria to determine the eligibility of articles.
- At the end of the first year, no differences were found among the non-drinkers, who improved by 13.1%, and among those who reduced consumption to g/d (with an average improvement of 12.2%).
- Thus, Nicolás et al73 studied the evolution of the ejection fraction in 55 patients with ACM according to their degree of withdrawal.
- Epidemiological studies analysing the relationship between excessive alcohol consumption and the development of DCM have found the existence of a reciprocal link between both disorders.
How we reviewed this article:
This observation led to the erroneous belief that alcohol is an immediate coronary vasodilator. Symptomatic relief of angina could be through the anesthetic effect of ethanol or through peripheral vasodilation, which could transiently reduce oxygen demand of the heart. The first paper to assess the natural history and long-term prognosis of ACM was published by McDonald et al69 in 1971. He recruited 48 patients admitted to hospital with cardiomegaly without a clear aetiology and severe alcoholism. The only factor to predict a poor outcome was the duration of symptoms before admission. 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.