The clinical presentation is dependent on the stage of the heart muscle disease. In the early ACM, patients are typically asymptomatic [11]. In more advanced disease, individuals manifest with congestive heart failure. Therefore, a clinical picture develops secondary to CHF and pulmonary edema. A majority will experience dyspnea on exertion. As ACM progresses, patients can develop orthopnea. Furthermore, some will have paroxysmal nocturnal dyspnea and episodic coughs that produce frothy sputum. Another common sign of CHF is peripheral edema which is enhanced in patients with cirrhosis. Patients with arrhythmias may feel palpitations. 

Sudden cardiac death may occur in individuals with dilated cardiomyopathy [12].

Other

Since alcohol affects many organs and systems, alcoholics will typically display signs of thiamine and other vitamin deficiencies. Of importance, liver cirrhosis is prevalent in this group. Therefore, these patients will likely have other sequelae in addition to cardiovascular involvement. 

• Congestive Heart Failure

  Structural changes have been noted in autopsies of chronic alcoholics without congestive heart failure. [symptoma.com]

  Abstract We prospectively evaluated the long-term prognosis of 14 patients with alcoholic cardiomyopathy and severe end-stage congestive heart failure after total abstinence. [ncbi.nlm.nih.gov]

• Fatigue

  These symptoms can include the following: Ankle, feet, and leg swelling (edema) Overall swelling Loss of appetite Shortness of breath (dyspnea), especially with activity Breathing difficulty while lying down Fatigue, weakness, faintness Decreased alertness [en.wikipedia.org]

  Symptoms include fatigue, shortness of breath, swelling, and cough. Muscular weakness may also be present because of the effect of alcohol on muscles (alcoholic myopathy). Treatment includes quitting drinking. [mottchildren.org]

  Case report: Case A: A 52 year-old man presented with fatigue, dyspnea, FC III from many years ago. He had previous history of increased TG and cigarette smoking. He had normal BP and FBS, TFT. [apjmt.mums.ac.ir]

• Leg Swelling

  These symptoms can include the following: Ankle, feet, and leg swelling (edema) Overall swelling Loss of appetite Shortness of breath (dyspnea), especially with activity Breathing difficulty while lying down Fatigue, weakness, faintness Decreased alertness [en.wikipedia.org]

  Leg swelling was bilateral and progressive. There was no facial or abdominal swelling. She admitted to some reduction in urine volume. There was no hematuria, dysuria or frothiness of urine. [ispub.com]

  People with alcoholic cardiomyopathy who are symptomatic may experience a range of symptoms in different parts of the body, including: Leg swelling Shortness of breath Fatigue, weakness Enlarged liver Cough with pink, frothy mucus Fainting, dizziness [michaelshouse.com]

  legs * Swelling in other parts of the body * Decreased production of urine * The need to urinate during the middle of the night * A cough that produces sputum with a pink tinge * Fast or irregular pulse * Shortness of breath that develops with activity [alcoholrehab.com]

• Chills

  Photo Credit Dolly Faibyshev for The New York Times Work Out and Chill? Cool temperature workouts may be the answer for those who want to exercise without becoming a hot mess. [nytimes.com]

  I would chill on how hard you push yourself working out until you get some answers or tests. 08-03-2006, 03:28 PM # 8 Senior Veteran (male) Join Date: Jul 2004 Posts: 1,563 Re: alcoholic cardiomyopathy It is true the type of heart muscle disease produced [healthboards.com]

• Rigor

  Flair made sure to note to Meltzer that he was cleared to wrestle by his doctor in the spring of 2003 and underwent rigorous cardiovascular testing thanks to WWE's Wellness policy between 2006 and 2008, which flagged up no further problems. [cagesideseats.com]

• Dyspnea at Rest

  There are five useful clinical signs to establish the presence and severity of cardiomyopathy: general appearance (cachexia and dyspnea at rest indicate severe impairment), hypotension, tachycardia, elevated jugular venous pressure, and displaced left [clevelandclinicmeded.com]

• Overeating

  The author reports a case of normalization of severe left ventricular dysfunction over a prolonged period in a patient with alcoholic cardiomyopathy who abstained from alcohol. [ncbi.nlm.nih.gov]

• Heart Disease

  Management of heart failure is traditional in these patients. Atrial arrhythmias have been shown to occur during the early ethanol withdrawal phase in patients without other clinical evidence of heart disease. [ncbi.nlm.nih.gov]

  Funding and Disclosures Presented in part at a symposium on alcoholism and heart disease, American College of Cardiology, Chicago, March 2, 1972. [nejm.org]

  Key Points The toxic effects of alcohol may cause supraventricular arrhythmias, sudden death, hypertensive heart disease and stroke. Acute, untreated alcohol withdrawal has been associated with takotsubo cardiomyopathy. [cardiologytoday.com.au]

• Cardiomegaly

  Key features of alcoholic cardiomyopathy are cardiac hypertrophy and ventricular dilatation, and the disease is manifested mainly as cardiomegaly, congestive heart failure, and even cardiac death. [ncbi.nlm.nih.gov]

  Blood tests will show signs of liver injury and confirm alcohol abuse, while chest X-ray shows pulmonary congestion, cardiomegaly and pleural effusions. [radcliffecardiology.com]

  This disease is usually manifested by dyspnea and palpitations with cardiomegaly and congestive heart failure (heart failure) ICD-9-CM Volume 2 Index entries containing back-references to 425.5 : Alcohol, alcoholic cardiopathy 425.5 Beer-drinkers' heart [icd9data.com]

  Chest X ray revealed global cardiomegaly and wide carina angle. ECG showed LAE and sinus tachycardia. Coronary angiogram demonstrated normal coronary arteries. Echocardiography showed LVEF=30%, LAE, LVE, RVE and trace pericardial effusion. [apjmt.mums.ac.ir]

• Tachycardia

  ECG showed LAE and sinus tachycardia. Coronary angiogram demonstrated normal coronary arteries. Echocardiography showed LVEF=30%, LAE, LVE, RVE and trace pericardial effusion. [apjmt.mums.ac.ir]

  […] 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) Heart palpitations (irregular heart beat) Rapid pulse (tachycardia [en.wikipedia.org]

  In trials carried out by Fauchier et al., it turned out that frequency of atrial arrhythmias and also ventricular tachycardias does not differ significantly both in patients with idiopathic and alcoholic cardiomyopathy. [termedia.pl]

  This is also a common entity that occur during persistent sinus tachycardia or AF, thyrotoxicosis.Beta blockers are of great use here. Recovery is usual if the primary cause is correctable. [drsvenkatesan.com]

  Tachycardia-induced cardiomyopathy Pregnancy Peripartum cardiomyopathy © 2003 The Cleveland Clinic Foundation. [clevelandclinicmeded.com]

• Heart Murmur

  However, as the disease reaches advanced stages, congestive heart failure may occur. Commonly, a person affected by alcoholic cardiomyopathy experiences discomfort and chest pain. Chest examination may reveal heart murmur. [ic.steadyhealth.com]

  Clinical findings Heart failure, anasarca and peripheral oedema, anorexia, shortness breath, dependent dyspnoea, oliguria, nocturia, palpitations, thready pulse. Diagnosis Heart murmurs, EKG changes, enlarged heart by imaging. [medical-dictionary.thefreedictionary.com]

  Such factors include an enlarged heart, a heart murmur, sounds of congestion in the heart and/or lungs, swelling in the jugular veins in the neck, and swelling in legs, ankles, and feet. [therecoveryvillage.com]

  These simple tests allow your doctor to identify potential signs of alcoholic cardiomyopathy or heart failure, including: an enlarged heart sounds of a heart murmur from valve damage sounds of congestion in the heart and lungs swelling of the jugular [healthline.com]

• Irregular Heart Rhythm

  Binge drinking -- four or more drinks for women and five or more for men in about 2 hours -- can cause irregular heart rhythms called arrhythmias. [webmd.com]

  This will demonstrate implementing the above steps is having a positive effect on your health. #4: Irregular heart rhythm/arrhythmia Arrhythmia is a condition when you experience an irregular heart rhythm. [rehab-recovery.co.uk]

• Hepatomegaly

  Abdominal examination revealed a tender hepatomegaly, and a non tender suprapubic mass of about 18wks size. CXR showed upper lobe diversion, pulmonary congestion and a globular cardiomegaly with mitralization of the left heart border. [ispub.com]

  Patients indulging in alcohol and having symptoms of myocarditis, have worse prognosis, because coexistence of these two factors intensifies the signs of left and right ventricular heart failure: tachycardia, supraventricular and ventricular arrhythmias, hepatomegaly [termedia.pl]

  Jugular venous distention, peripheral edema, and hepatomegaly are evidence of elevated right heart pressures and right ventricular dysfunction. [emedicine.com]

• Sweating

  They include trouble sleeping, shakiness, irritability, anxiety, depression, restlessness, nausea, and sweating. In severe cases, you could have a fever, seizures, or hallucinations. [icdlist.com]

  […] heavy prolonged alcohol use alcohol withdrawl what happens on the 2nd to the 3rd day of alcohol withdrawl delirium tremors worst withdraw a person can have delirium tremors signs and symptoms of alcohol withdrawl n&v, malaise,weakness, tachycardia, sweating [memorize.com]

  __________________ The cure for anything is salt water: sweat, tears, or the sea. ~ Isak Dinesen The Following User Says Thank You to biminiblue For This Useful Post: 03-15-2017, 10:42 AM # 6 ( permalink ) Member Join Date: Mar 2017 Posts: 15 I am not [soberrecovery.com]

  An acute pancreatic attack causes symptoms including: Abdominal pain, which may radiate up the back Nausea and vomiting Fever Rapid heart rate Diarrhea Sweating Chronic pancreatitis causes these symptoms as well as severe abdominal pain, significant reduction [collegedrinkingprevention.gov]

• Denial

  This can be particularly difficult for those alcohol abusers who are in denial about their problem. [michaelshouse.com]

  Alcoholism is a disease that is characterized by denial, so, while you may not be able to change the behavior of someone you love, you still need to get help for yourself because alcoholism becomes a family illness. [womensheart.org]

• Oliguria

  Loss of appetite Shortness of breath (dyspnea), 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 [en.wikipedia.org]

  Need to urinate at night (nocturia) and decreased urine production (oliguria) also accompany the disease. [ic.steadyhealth.com]

  Clinical findings Heart failure, anasarca and peripheral oedema, anorexia, shortness breath, dependent dyspnoea, oliguria, nocturia, palpitations, thready pulse. Diagnosis Heart murmurs, EKG changes, enlarged heart by imaging. [medical-dictionary.thefreedictionary.com]

  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 coughed up Decreased urine output (oliguria [aa.activeboard.com]

  […] swelling Awakening during the night with shortness of breath (paroxysmal nocturnal dyspnea) Breathing difficulty while lying down (orthopnea) Cough containing mucus, or pink, frothy material Decreased alertness or concentration Decreased urine output (oliguria [flipper.diff.org]

The workup consists of a detailed history including assessment of amount and duration of alcohol use. Also, a thorough physical exam should be performed to determine the complete clinical picture. Of importance, there are pertinent studies to help achieve the diagnosis of ACM. Early diagnosis and treatment may reverse some of the cardiac damage. Hence, it is important to recognize and address the overall health of the alcoholic patient. 

Laboratory test

B-type natriuretic peptide (BNP) levels are sensitive for congestive heart failure. The levels of BNP can be elevated as this substance is released from the stressed ventricles.

Imaging

Echocardiography is essential as it provides measurements of the wall thickness, which are normal or reduced. Additionally, this modality yields information about the systolic and valvular function and contractility, which are usually impaired [11].

A chest radiograph may reveal evidence of heart failure [11], such as cardiomegaly, alveolar edema, pleural effusions, Kerley B lines, and other signs as well.

Cardiac catheterization evaluates systolic and diastolic performance in addition to the hemodynamic status [13]. Another technique, thallium scintigraphy, may show ischemic areas [13].

Electrocardiography (ECG)

This study identifies structural changes such as left ventricular hypertrophy [11] and any present arrhythmias. 

Other

Since alcoholics are predisposed to other organ and system involvement, more tests may be warranted depending on the overall clinical picture of the patient. Additionally, testing for vitamin deficiencies and electrolyte imbalance are indicated as well. These especially include thiamine, potassium, phosphorus, and magnesium levels.

• Myocardial Fibrosis

  The combination of myocyte injury and necrosis associated with myocardial fibrosis results in impaired mechanical function. [clevelandclinicmeded.com]

  The efficacy of abstinence has been shown in persons with early disease (eg, prior to the onset of severe myocardial fibrosis) and in individuals with more advanced disease (see Prognosis). [emedicine.com]

• Left Ventricular Hypertrophy

  ST segment and T wave abnormalities, left ventricular hypertrophy, biatrial enlargement, left atrial enlargement, premature ventricular contractions, prolonged PR interval, and left anterior hemiblock are the most frequently encountered abnormalities. [ncbi.nlm.nih.gov]

  Electrocardiography (ECG) This study identifies structural changes such as left ventricular hypertrophy and any present arrhythmias. [symptoma.com]

  The most commonly associated condition is hypertension, particularly if complicated by left ventricular hypertrophy. [aafp.org]

  The Following User Says Thank You to Clean30 For This Useful Post: 03-15-2017, 09:49 AM # 3 ( permalink ) Dismember Join Date: Aug 2008 Location: The Mitten, USA Posts: 1,641 Blog Entries: 2 I have left ventricular hypertrophy, which could've developed [soberrecovery.com]

  Echocardiography and magnetic resonance imaging revealed severe basal hypertrophy of the interventricular septum (19 mm), dynamic left ventricular outflow tract obstruction with a gradient of 70 mmHg at rest and 120 mmHg with Valsalva maneuver, and systolic [revportcardiol.org]

The primary therapy of ACM is the withdrawal of the source. Hence, the patient should be aided and encouraged to cease and abstain from alcohol. This includes providing the patient with education, counseling, and resources to guide the challenging process. Alcohol cessation in the early stages of ACM may reverse the damage. In fact, it is also beneficial to abstain in later stages as well.  

Medical treatment involves the same approach as in heart failure secondary to other causes. The main cardiovascular drugs are vasodilators, digoxin, and diuretics [11] [13]. The vasodilators ACE inhibitors and angiotensin receptor blockers may even prevent the development of ACM [14]. Digoxin is useful for those with symptomatic left ventricular dysfunction while diuretics are helpful for symptomatic relief. Beta blockers could be beneficial for stable cases while intravenous inotropic drugs may be indicated for certain patients. Heart transplantation may be necessary for those with advanced disease. 

Another therapeutic aspect is the cautious use of anticoagulants in patients with left ventricular impairment and atrial fibrillation. 

Since patients with prolonged abuse of alcohol are prone to vitamin insufficiencies, treatment with thiamine, vitamin B-12, folate, and mineral supplementation is advised. Any electrolyte imbalance should be treated early to help prevent the occurrence of an arrhythmia and sudden death. 

The prognosis for recovery depends on the length and amount of alcohol use. If the heart is damaged, then full recovery is highly unlikely. However, if patients with early disease cease consumption of alcohol. Then the damage is reversible to a certain degree.   

Chronic alcohol intake can result in congestive heart failure (CHF), arrhythmias, and sudden cardiac death. 

As the name suggests, this type of cardiomyopathy is caused by alcohol. While there is no set amount of alcohol intake or duration of use correlated with the severity of the disease, asymptomatic alcoholics may exhibit cardiac changes if they use more than 90 grams of alcohol daily for a duration greater than 5 years. Furthermore, symptomatic patients have likely consumed excessive alcohol for a decade or more [2].

The heart is one of many organs affected by alcohol abuse as this substance is toxic to the myocardial cells. Specifically, alcoholic cardiomyopathy causes an impaired contractility [3] resulting in structural changes such as hypertrophy to accommodate the extra blood [4]. Furthermore, the cardiac dysfunction leads to a compensatory increase in blood pressure. The resultant hypertension produces damage to the myocardium, valves and blood vessels.

ACM occurs in correlation with prolonged and high levels of alcohol intake. However, not all alcoholics develop this condition. The prevalence ranges from 23% to 40% [5]. 

The patient demographic demonstrates a gender preference with men accounting for 86% of all cases. Additionally, mortality is higher in men than women. With regards to race, death rates are greater in African Americans than white people [6]. 

ACM is implicated in approximately 3.8% of all cases of cardiomyopathy [6]. In fact, chronic alcohol abuse is the second most common etiology of dilated cardiomyopathy, a condition observed more in alcoholics than the general population. 

The deterioration of the cardiac function in alcoholics is related to a complex pathophysiology.  In asymptomatic cases, there is cardiac dysfunction, but clinical manifestations such as dyspnea do not emerge until advanced disease. Structural changes have been noted in autopsies of chronic alcoholics without congestive heart failure [7]. 

In a study assessing chronic alcoholics without cardiac symptoms, echocardiography revealed abnormal left ventricular diastolic function with altered early and late diastolic filling velocity. These observations in the early stages of alcohol abuse have been corroborated in other investigations as well. Further findings demonstrate systolic dysfunction as indicated by a prolonged pre-ejection period (PEP) and a diminished left ventricular ejection time (LVET). Specifically, the elevated  PEP/LVET ratio reflects reduced myocardial function [8]. 

Gender variability has been demonstrated in a study evaluating carotid pulse measurements in asymptomatic ACM patients. Men exhibited changes in PEP and LVET while women did not. 

Long-term and heavy alcohol use in men makes them susceptible to arrhythmias and sudden cardiac death. The most frequent sequel in acute and chronic alcoholics is atrial fibrillation [9]. The pathogenesis of atrial fibrillation has not been fully established. It is believed that the weakened cardiac performance and rhythmicity resulting from alcoholism are likely secondary to multiple changes in cellular processes. 

Finally, dilated cardiomyopathy is a consequence of vitamin and nutritional deficiencies such as thiamine [10]. These are attributed to alcoholism. 

The primary method of preventing ACM is by avoiding excessive consumption of alcohol. Patients should be educated on what constitutes moderate intake. They should also be counseled on signs of addiction and be made aware of all available resources.

With regards to preventing heart disease, patients should be educated about eating healthy, exercising, maintaining healthy weight, achieving glycemic control, and smoking cessation/abstinence. 

Alcoholic cardiomyopathy (ACM), a form of dilated cardiomyopathy, develops in individuals with chronic and heavy alcohol consumption [1]. The heart muscle becomes weak and this results in limited contractility and eventually cardiac failure. Other risk factors such as hypertension, smoking, and diabetes mellitus are typically present in these patients.

There are two stages of this disease which are asymptomatic and symptomatic. The pathophysiology involves a process of cardiovascular changes in which the heart pump function becomes diminished causing the compensatory heart enlargement to accommodate for the extra blood. Consequently, diastolic dysfunction is exhibited followed by systolic dysfunction and eventually congestive heart failure. The latter produces symptoms. In men, sudden cardiac death is a risk especially in the setting of fatal arrhythmias.

Diagnosis is achieved through obtaining the medical and social history, physical exam, laboratory studies, and cardiac imaging. The echocardiogram is very important as it provides information on the heart size and overall function. Other imaging techniques are also useful. 

Management involves cessation of alcohol and treatment of heart failure with standard medications such as vasodilators, digoxin, beta blockers, and diuretics. 

Early diagnosis and treatment may reverse the cardiac damage. Additionally, any patient exhibiting signs of alcoholism should prompt studies regarding vitamin deficiencies and electrolyte abnormalities. Also, other risk factors should be addressed and controlled. 

Alcoholic cardiomyopathy is a condition that results from drinking too much alcohol over years. The excessive alcohol causes toxic effects on the heart cells and, therefore, the muscle of the heart becomes too weak to pump blood efficiently. This means that the body receives less blood supply and hence experiences damage to organs and tissues. Over years of heavy abuse, the heart fails and the patients experience symptoms.

In the early stages of the disease, the patients do not have symptoms even though the heart undergoes structural changes. Once it becomes advanced, heart failure symptoms being to manifest. These include:

• Swelling of the legs
• Waking up at night due to shortness of breath
• A productive cough with frothy sputum
• Shortness of breath while resting
• Shortness of breath with physical activity
• Decreased concentration
• Weakness and fatigue
• Fainting episodes
• Feeling heart beat sensations known as palpitations
• Rapid and abnormal pulses

The diagnosis is determined when the clinician obtains the patient's history and performs a physical exam. Laboratory tests are also helpful. Additionally, imaging techniques such as an echocardiogram will provide beneficial information on the size of the heart, the function of the valves and the pumping function. An EKG will show abnormal heart rhythms (if present) and findings suggestive of an enlarged heart. A chest x-ray can show evidence of heart failure such as fluid buildup in the lungs. 

The main therapy is quitting alcohol and remaining abstinent. This is a challenging task but the patient should be provided with education, counseling, and resources to help. The treatment of heart failure includes medications such as ACE inhibitors, beta blockers, digoxin, diuretics, and others as needed. 

In cases with advanced cardiomyopathy, heart transplantation may be needed. 

Since alcoholics tend to have vitamin and electrolyte deficiencies, these should be treated promptly to help prevent further complications.

1. McKenna CJ, Codd MB, McCann HA, et al. Alcohol consumption and idiopathic dilated cardiomyopathy: a case control study. American Heart Journal. 1998; 135(5 Pt 1):833.
2. Mathews EC, Gradin JM, Henry WL, et al. Echocardiographic abnormalities in chronic alcoholics with and without overt congestive heart failure. American Journal of Cardiology. 1981; 47(3):570-578.
3. Sarma JS, Ikeda S, Fischer R, et al. Biochemical and contractile properties of heart muscle after prolonged alcohol administration. Journal of Molecular and Cellular Cardiology. 1976; 8(12):951–972.
4. Kupari M, Koskinen P, Suokas A, et al. Left ventricular filling impairment in asymptomatic chronic alcoholics. American Journal of Cardiology. 1990; 66(20):1473–1477.
5. Fauchier L, Babuty D, Poret P, et al. Comparison of longterm outcome of alcoholic and idiopathic dilated cardiomyopathy. European Heart Journal. 2000; 21(4):306–314.
6. Hyattsville. Vital and Health Statistics. Department of Health and Human Services. Centers for Disease Control and Prevention. 1995; 13(122).
7. Skinner HA, Holt S, Sheu WJ, et al. Clinical versus laboratory detection of alcohol abuse: the alcohol clinical index. British Medical Journal (Clinical Research Ed). 1986; 292(6537): 1703-1708.
8. Levi GF, Quadri A, Ratti S, Basagni M. Preclinical abnormaltiy of left ventricular function in chronic alcoholics. British Heart Journal. 1977; 39: 35-37.
9. Conen D, Tedrow UB, Cook NR, et al. Alcohol consumption and risk of incident atrial fibrillation in women. Journal of American Medical Association.2008; 300(21): 2489-2496.
10. Klatsky AL. Alcohol and Cardiovascular Health. Integrative and Comparative Biology. 2004 August; 44(4):324-328.
11. Wexler RK, Elton T, Pleister A, et al. Cardiomyopathy: an overview. American Family Physician. 2009; 79(9):778-84.
12. Binham JD, Fredlund V. A case of dilated cardiomyopathy. Rural and Remote Health. 2012; 2143.
13. Massin EK. Current Treatment of Dilated Cardiomyopathy Texas Heart Institute Journal. 1991; 18(1):41-49.
14. Cheng CP, Cheng HJ, Cunningham C, Shihabi ZK, Sane DC, Wannenburg T, Little WC.  Angiotensin II type 1 receptor blockade prevents alcoholic cardiomyopathy. Circulation. 2006;114(3):226-36.