Alcoholic cardiomyopathy is a type of cardiomyopathy that is the result of long-time alcoholic consumption as its cause. It is defined by the damage and weakening of the myocardial cells of the heart, decreased efficiency of the cardiac pump function, and possible development of heart failure. This condition is observed in persons who were habitual and chronic alcohol consumers for a significantly long time, often over several years. 

No level of alcohol consumption can provide absolute certainty that the individual is protected against the formation of alcoholic cardiomyopathy. Nonetheless, this study confirms that the probability of developing HCC is considerably higher when the subject abuses or overindulges in alcohol and exceeds two units of alcohol per day for men and one unit for women per day for a long time. 

It is also important to understand that the incidence and prevalence of alcoholic cardiomyopathy can slightly differ from population to population and from region to region. It is more frequent in countries that have high alcohol consumption rates as part of their population’s lifestyle. The extent of alcoholic cardiomyopathy rises with the duration and severity of the alcohol consumption. 

Heavy regular alcohol drinking, commonly measured as over two units per day in men and one unit per day in women, substantially increases the likelihood of developing the condition. Alcoholic cardiomyopathy manifests more commonly in males than in females primarily due to the predisposing reason of drinking alcohol in males. 

Alcoholic CM is a multifactorial disorder, and the pathophysiological feature of the condition includes specific morphological and functional alterations in the myocardial tissue. Alcohol use results in various physiological changes and affects the heart muscle making it dilate, pump blood inefficiently. Being a toxicological agent, ethanol as a primary component of alcoholic beverages, accumulate toxic active metabolites, which cause cell death and inflammation of cardiac muscle cells. Alcoholism also results in poor diet and malnutrition with deficiencies in thiamine, niacin and vitamins. This oxidative stress affects the heart muscles and makes it harder for people with existing heart diseases. 

Alcohol metabolism 

Oxidative stress 

Nutritional deficiencies 

Impaired protein synthesis 

The prognosis for individuals with alcoholic cardiomyopathy can vary widely depending on several factors, including the severity of the condition, the individual’s overall health, their commitment to lifestyle changes, and the timely management of the disease. Generally, it is a serious condition that can lead to significant complications and even death if not properly addressed. 

Alcoholic cardiomyopathy is a form of heart failure with features of dilated cardiomyopathy with decreased systolic function. The patients may present complaints of shortness of breath, palpitations, and episodes of fainting. Diastolic dysfunction is an early sign that has been documented in 30% of individuals with a chronic alcohol abuse history, before systolic dysfunction or left ventricular hypertrophy is manifested. 

Alcoholic cardiomyopathy may show symptoms of congestive heart failure such as increased venous pressure, distended veins in the throat, swelling of the legs and ankles, an enlarged liver, fluid accumulation in the abdomen, abnormal heart sounds, an elevated heart rate, an irregular heartbeat, crackles in the lungs, and blood pressure where the pulse varies between full and weak. This is followed by severe symptoms where the heart muscles may weaken, and the patients may lose weight due to chronic heart failure and the fingertips may become clubbed. 

Alcohol Cessation Primary Intervention: The final effective but highly critical measure is to abstain from alcohol use altogether. This may arrest further deterioration of heart damage and in some cases result in improvement of heart function. 

Pharmacological Treatment Heart Failure Management: Beta adrenergic blocking agents and vasodilators that are used for the management of heart failure are commonly used. 

• Diuretics: May contribute to the prevention of fluid overload and oedema. 

• ACE Inhibitors or ARBs: To lower down the blood pressure and to ease out the pressure working on the heart. 

• Beta-blockers: Enhance the heart’s capacity to pump blood more effectively and minimize the symptoms. 

• Digitalis: May be used in certain instances as an agent to enhance the strength of heart contractions. 

Nutritional Support Balanced Diet: A combination of fruits and vegetables and decreased intake of fats as well as consumption of lean meats and whole grain foods. 

Salt Restriction: It is recommended to take least quantities of sodium with an aim of minimizing the chance of fluid retention. 

Nutritional Supplements: Thiamine (Vitamin B1) and other B vitamins because the patient is an alcoholic and mostly B vitamins are deficient in such patients. 

Lifestyle Modifications  

Regular Exercise: Structured according to the patient’s ability and if administered under the supervision of health care givers. 

Weight Management: Avoiding obesity to decrease the workload placed on the heart.  

Smoking Cessation: If possible, along with smoking that increases the risk of cardiovascular diseases even more. 

Cardiology, General

Alcohol Cessation: The first and most effective nonpharmacological therapy is the complete and permanent abstinence from alcohol. Such approaches of treatment as cognitive-behavioural therapy and motivational interviewing can be effective while treating addiction. 

Nutritional and Dietary Modifications: Eating foods containing pre-determined quantities of saturated fats and cholesterol and reduced levels of sodium. Increasing the intake of fruits and vegetables and replacing refined grains with complex ones and unhealthy fats with lean proteins. For decreasing sodium intake to control the levels of fluid that accumulate in the body and high blood pressure. 

Lifestyle Changes: Adequate physical activity that should be moderate and regular and should be adjusted according to the patient’s capabilities. Physical activity can enhance the quality of disposition by increasing the density of coronary arteries and overall circulation. Cardiac rehabilitation programs can present an individual with professionally designed and monitored exercise regimens. 

Cardiology, General

Nephrology

Furosemide: It competes with sodium chloride reabsorption along the ascending limb of the Henle’s loop in the kidneys. This results in enhanced elimination of sodium, chloride and water thereby decreasing fluid accumulation. It is often taken orally, where dosages ranging from 20 to 80 mg per day are given initially based on the severity of the symptoms and response to treatment. For acute care or severe pain, the administration may be via the intravenous route. 

Cardiology, General

Losartan: It inhibits the action of angiotensin II by blocking its binding to the angiotensin II receptor which in turn reduces vasoconstriction and hence release of aldosterone. This led to dilatation of blood vessels, lowering of blood pressure, and reduction in the workload of the heart. 

Initial dose: It is also taken at a starting dose of 50 mg once daily and increased according to response and tolerability. The dosage may be changed depending on the blood pressure regulation and pain relief, and it should not exceed 100 milligrams per day. 

Cardiology, General

Enalapril: It works in reducing the levels of angiotensin II in the body through blocking the conversion of angiotensin I to angiotensin II, thus causing vasodilation, decreased aldosterone secretion, and decrease in blood pressure. 

Cardiology, General

Metoprolol succinate: It is a long acting B1 selective beta blocker that works by decreasing cardiac output, heart rate, myocardial contractility and arterial blood pressure to minimize the workload of the heart and therefore the oxygen demand. 

Cardiology, General

Implantable Cardioverter Defibrillator (ICD): For cases of severe heart failure or for those patients who are considered at risk for sudden cardiac death owing to arrhythmias. 

Cardiac Resynchronization Therapy (CRT): For enhancing the heart function in patients with a diagnosis of heart failure and ventricular dyssynchrony.
Coronary Artery Bypass Grafting (CABG) or Percutaneous Coronary Intervention (PCI): In patients with established CAD, defined as more than 70% stenosis in at least one coronary artery. 

Heart Transplant: In cases of end-stage heart failure when conventional therapies have failed to provide satisfactory results. 

Cardiology, General

• Assessment and Diagnosis: Diagnostic evaluation in which patient’s history, physical examination, echocardiography, and cardiac catheterization might be performed to reach the initial diagnosis.
  Alcohol Cessation: The first and the most vital goal is an absolute abstinence from alcohol to eliminate the risk of further compromised heart muscles. 
• Management of Heart Failure: 
• Medications: Medications, including ACE inhibitors, beta-blockers, diuretics, and aldosterone antagonists may be prescribed if the individual has severe heart failure to manage the symptoms and enhance the function of the heart. 
• Devices: For severe conditions, other devices such as the implantable cardioverter-defibrillators (ICDs) or cardiac resynchronization therapy (CRT) devices may be considered. 
• Lifestyle Changes: Promoting good nutrition, exercise and following the clinician’s recommendation of a heart-friendly diet, regular physical activity as allowed, and optimization of weight. Follow-up visits controlling the condition of the heart and making corresponding changes to the medications. 
• Treatment of Coexisting Conditions: Treating other associated factors of heart diseases like hypertension, diabetes through the right approaches.
  Supportive Therapy: In addition, dietary management, as well as the administration of thiamine (vitamin B1) as alcoholism may be associated with the deficiency of this vitamin. Alcohol counselling and support groups for managing alcohol withdrawals and for individuals seeking and maintaining effective transition to an alcohol-free lifestyle.