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Manage Alcoholic Cardiomyopathy − Symptoms, Causes and Treatment

Last Updated: April 16, 2024

Reviewed by Dr. Ash Bhatt

In the U.S., heart disease is the primary cause of mortality across most genders, races and ethnicities, claiming lives every 33 seconds in the country.

Excessive alcohol consumption significantly contributes to this reality, leading to several cardiovascular diseases such as hypertension, coronary heart disease, stroke, cardiomyopathy and peripheral arterial disease. Alcoholic cardiomyopathy (ACM) impairs the heart’s capacity to pump oxygen-rich blood around the body.

This heart dysfunction causes faints, shortness of breath, fluid retention, and overall decreased quality of life. Read on to learn about alcohol-induced cardiomyopathy diagnosis, treatment and prevention.

What is Alcoholic Cardiomyopathy?

Alcohol-induced cardiomyopathy is a heart muscle disease caused by chronic alcohol consumption since no other origin is known. This heart disease is characterized by impaired contraction and dilation of one or both ventricles of the heart.

Here’s what happens during alcohol-induced cardiomyopathy:

  • Alcohol is cardiotoxic and directly damages heart muscle cells, impairing their ability to contract
  • The heart chambers, particularly the left ventricle, may enlarge due to weakened heart muscle
  • Weakened muscle fibers impair the heart’s ability to pump blood throughout the body
  • Heart muscle damage causes irregular heart rhythms, causing palpitations, dizziness or fainting
  • As heart function declines, fluid may build up in the lungs and other tissues
  • Presence of symptoms of heart failure such as fatigue, rapid or irregular heartbeat

Alcoholic cardiomyopathy most commonly affects men aged 30-55 (+10 years of use). Although women represent about 14% of ACM cases, biological differences result in women absorbing more alcohol and they typically develop this heart condition with less lifetime alcohol use.

Symptoms of Alcohol-Induced Cardiomyopathy

According to clinical research, most of the symptoms of alcoholic-induced cardiomyopathy occur when the disease is irreversible and advanced and may start with signs of congestive heart failure.

Among the symptoms of ACM are:

  • Diastolic dysfunction (early sign)
  • Gradual onset worsening shortness of breath
  • Orthopnea (difficulty breathing while lying flat)
  • Paroxysmal nocturnal dyspnea (waking up at night unable to breathe)
  • Palpitations and syncopal episodes due to tachyarrhythmias
  • Chest pain or discomfort
  • Swelling in the legs, ankles and abdomen
  • Rapid weight gain due to fluid retention
  • Tachyarrhythmias, notably atrial fibrillation
  • Non-specific signs of congestive heart failure such as anorexia, generalized cachexia, muscular atrophy

Diagnosis and Tests for Alcoholic Cardiomyopathy

The exact amount and duration of alcohol consumption associated with ACM remains unknown. According to studies, daily alcohol intake of 80 g per day or more for more than 5 years significantly increases the risk. Yet, not all chronic alcohol users will suffer from this heart condition.

Clinicians must run various diagnostic tests to rule out differential diagnoses from other heart conditions.

Medical History Assessment

A healthcare provider will inquire about the patient’s alcohol consumption habits, including frequency, duration, and quantity of alcohol intake, symptoms suggestive of heart failure and other cardiac conditions.

Physical Examination

A thorough physical examination should be conducted to evaluate signs of heart failure, such as abnormal heart sounds (e.g., murmurs), fluid retention (e.g., peripheral edema, jugular venous distention) and physical signs that may point to alcoholic cardiomyopathy.

Laboratory Tests

There are no specific lab tests to diagnose ACM, but some may be useful for checking the extent of alcohol-induced damage. The first and most important diagnosis to rule out is coronary artery disease.

These tests may include, but are not limited to:

  • Blood tests to assess liver function (AST, ALT), markers of heart muscle damage (troponin, BNP).
  • Complete Blood Count (CBC) to evaluate for anemia and other blood abnormalities
  • Electrolyte levels to assess for imbalances that may affect heart function

Imaging Studies

Imaging provides detailed information about the structure and function of the heart. Imaging studies for alcoholic cardiomyopathy may include:

  • Echocardiogram (Echo) for detailed images of the heart’s structure and function
  • Electrocardiogram (ECG or EKG) to record the heart’s electrical activity and detect abnormal rhythms
  • Chest X-ray to reveal signs of heart enlargement, fluid accumulation in the lungs (pulmonary congestion)
  • A cardiac MRI or CT scan is recommended for more detailed images of the heart’s structure

Cardiac Catheterization

In some cases, cardiac catheterization may be recommended to evaluate coronary artery function and exclude significant blockages that could contribute to heart dysfunction.

Is It Alcoholic Cardiomyopathy Permanent?

Data shows that alcohol-induced cardiomyopathy is initially reversible.

However, since the prognosis is mostly reserved based on the severity of the case, which can be classified as i) acute, which involves myocardial inflammation, tachyarrhythmias, high concentration of troponin in serum and ii) chronic, which already caused multi-organ damage including myocardial dysfunction.

Acute cases of alcohol-induced cardiomyopathy may be reversible under total abstinence from alcohol, with first signs of improvement within the first month. Left ventricular function can improve within six months, with complete recovery within 18 months.

Prolonged and sustained alcohol use leads to irreversible dysfunction and the mortality rate for ACM can be as high as 50% in the following four years after diagnosis.

Alcoholic Cardiomyopathy Treatment

The best approach to treat alcohol-induced cardiomyopathy is addressing the source of the disease. Complete abstinence from alcohol is crucial to prevent further damage to the heart muscle.

  • Medications such as ACE inhibitors, beta-blockers and diuretics may be prescribed to manage symptoms
  • If arrhythmias are present, medications to control heart rhythm may be necessary
  • Supplementation with vitamins and minerals, especially thiamine (vitamin B1) and magnesium
  • Limiting sodium intake to manage fluid retention
  • Appropriate exercise to improve cardiovascular fitness
  • Psychological support and counseling to address alcohol abuse and maintain sobriety
  • Regular medical monitoring, including echocardiograms and other diagnostic tests

Alcoholic Cardiomyopathy − Key Takeaways

As the exact amount and duration of alcohol consumption associated with the development of alcohol-induced cardiomyopathy remains unknown, the best prevention is avoiding alcohol intake, trying alcohol alternatives, or keeping intake moderate with no more than 10 standard drinks per week.

The development of heart diseases is multifactorial, involving not only alcohol intake but also genetic predisposition, diet and lifestyle choices. Yet, addressing alcohol use disorder is imperative to prevent further systemic damage and promote overall health.

Seeking professional assistance, attending Alcoholics Anonymous meetings, or accessing other support networks can provide invaluable help to overcome alcohol use disorder.

People Also Ask

Can you recover from alcoholic cardiomyopathy?

Some patients have shown improvement in left ventricular function within six months of stopping alcohol, with full recovery within 18 months. Abstaining from alcohol may lead to a full recovery in less severe cases. The effects of alcohol-induced cardiomyopathy may be lifelong for most chronic cases.

What is the life expectancy of someone with alcoholic cardiomyopathy?

People who stop drinking alcohol entirely usually have improved outcomes. Without full abstinence, the 4-year mortality rate for ACM can be as high as 50% and ACM is a common cause of death among long-term heavy drinkers.

How does alcohol cause cardiomyopathy?

Alcohol causes cardiomyopathy by directly damaging heart muscle cells, impairing their function. Prolonged alcohol abuse weakens the heart muscle, leading to enlargement of the heart chambers, reduced pumping ability and ultimately heart failure.

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Page Sources

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    Retrieved on April 16, 2024.

    Published on: March 9th, 2018

    Updated on: April 16th, 2024

    María José Petit-Rodríguez

    About Author

    María José Petit-Rodríguez

    Medically Reviewed by

    Dr. Ash Bhatt

    Throughout his professional life, Dr. Bhatt has been conferred with diplomate status by the American Board of Psychiatry and Neurology, certifying him in both adult and child/adolescent psychiatry. His experiences in emergency rooms, frequently encountering patients with simultaneous health and addiction issues, directed his attention to these specific fields.

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