Alcoholic cardiomyopathy is a lesion of the heart muscle, which is formed against the background of excessive alcohol consumption, manifested by a variety of morphological, functional, clinical disorders. Patients complain of pain behind the sternum, shortness of breath, swelling, cold of the lower extremities. It is possible to develop heart failure, deadly rhythm disturbances, thromboembolism. Alcoholic cardiomyopathy is diagnosed using ECG, Echo-KG, radiography. Treatment is conservative, with irreversible changes in the organ, a heart transplant is indicated.
I42.6 Alcoholic cardiomyopathy
Alcoholic myocardial damage is a common cause of cardiomyopathy. The occurrence is determined by the prevalence of alcoholism in the population. The disease develops more often in middle-aged people who regularly consume alcohol for a long time. There is a predominance of males among patients. The probability of pathology increases with smoking, stress, and the presence of other factors contributing to the occurrence of heart and vascular diseases. Alcoholic cardiomyopathy accounts for at least 30% of cases of dilated cardiomyopathy.
Causes of alcoholic cardiomyopathy
The main etiofactor is the prolonged consumption of a large amount of alcoholic beverages, usually in the equivalent of 100 ml of pure ethanol every day for 10-20 years (according to statistics, in USA the average alcohol consumption per year per person is from 11 to 14 liters or about 35-40 ml per day). The disease is diagnosed in 50% of chronic alcoholics. Factors contributing to the occurrence of cardiomyopathy include hereditary predisposition, immune disorders, irrational nutrition, chronic stress, fatigue, smoking.
First of all, toxic products of alcohol metabolism, mainly acetaldehyde, have a negative effect on the myocardium. This substance is formed by liver cells after the breakdown of ethanol and then enters the bloodstream. Reaching the heart, it causes structural and functional disorders: it negatively affects the reproduction of contractile proteins of the heart muscle, reduces its strength, disrupts metabolism within cardiomyocytes (transport of lipids, potassium, calcium).
Metabolic disorders and electrolyte imbalance cause arrhythmias, a decrease in the functional activity of the heart, the development of fibrous changes. There is evidence that acetaldehyde affects the synthesis of certain compounds, in particular, it stimulates the production of pro-inflammatory cytokines and proteins that can provoke an autoimmune response. In addition, with a high blood content, ethanol and various substances added to alcoholic beverages — metal impurities (for example, cobalt), dyes, preservatives can have a direct toxic effect on the heart.
The systematization of the types of alcoholic cardiomyopathy is carried out taking into account the peculiarities of clinical symptoms, the severity of certain manifestations. The division is rather conditional, since the signs of the disease differ in variability — symptoms corresponding to different types of the disease can be detected in one patient. There are four forms of pathology:
- Classic. The clinical picture is dominated by heart failure. Upon cessation of alcohol consumption, positive clinical and echocardiographic dynamics are noted, the longer the abstinence period lasts, the better the patient’s condition becomes. The resumption of admission leads to a rapid deterioration of the condition, the reappearance and aggravation of symptoms.
- Pseudo-ischemic. The main manifestation is stabbing or aching pains in the cardiac region in the presence of ECG changes characteristic of coronary heart disease. Cardialgia occurs after alcohol consumption, is not associated with physical activity, is not stopped by nitroglycerin. The severity of symptoms gradually progresses.
- Arrhythmic. Cardiac arrhythmias prevail in the clinic. In 20% of patients, atrial fibrillation is detected, less often extrasystole, tachycardia, fluttering or atrial fibrillation is detected. A feature of arrhythmias of alcoholic etiology is their occurrence after massive intake of ethanol-containing beverages. Rhythm disturbances can be the first and often the only symptom of cardiomyopathy.
- Mixed. Combines the manifestations of all previous variants of myocardial damage. It is considered the most unfavorable, since the symptoms mutually aggravate each other, which significantly worsens the prognosis of the disease. In 30-40% of patients with this type of cardiomyopathy, ECG shows signs indicating a predisposition to severe ventricular arrhythmias, sudden cardiac death.
Symptoms of alcoholic cardiomyopathy
The onset of the disease is characterized by nonspecific manifestations resulting from functional disorders of various organs and systems 4-5 years after the systematic consumption of large volumes of alcoholic beverages. Patients complain of rapid fatigue after minor physical exertion, weakness, drowsiness, increased sweating. With intense exertion, prolonged pain in the chest, in the back of the head is possible. Rhythm disturbances are represented by extrasystole, tachycardia, a feeling of heart sinking. Vegetative disorders include a feeling of heat, trembling of the hands, redness of the skin of the face, agitation or lethargy. Usually symptoms appear the day after an alcoholic excess. During the period of abstinence from alcohol, the intensity of manifestations decreases. Symptoms can persist for up to 10 years.
With the continuation of systematic consumption of ethanol-containing beverages, myocardial hypertrophy develops, quickly followed by dilation. The chambers of the heart expand, their contractility decreases, which causes heart failure, stagnation of blood in the small and large circulatory circles. There is constant shortness of breath, attacks of suffocation at night, swelling of the lower extremities, cough (dry or with a small amount of light sputum) are added to the clinical picture of the disease. Cyanosis, cold hands, feet may be detected.
In the absence of treatment, irreversible structural changes of internal organs develop against the background of cardiomyopathy. Due to circulatory disorders, the work of the kidneys is disrupted, toxic metabolic products accumulate in the body, negatively affecting the activity of the central nervous system and internal organs. The defeat of the nervous system leads to encephalopathy, manifested by a decrease in cognitive functions, unmotivated aggression, anger, uncertain gait, sleep disorders. At the terminal stage, there are gross disorders of the nervous system, progression of cardiac, renal and hepatic insufficiency, leading to the death of the patient.
With alcoholic myocardial damage, there is a high risk of complications, including life–threatening ones. The most common consequence is a critical rhythm disturbance – ventricular fibrillation, which is characterized by ineffective contractions and leads to cardiac arrest without medical assistance. Against the background of functional insufficiency of the heart muscle, the movement of blood in the chambers slows down, its rheological properties are violated, the likelihood of thromboembolic complications with the development of stroke, myocardial infarction, acute renal failure, necrosis of various parts of the gastrointestinal tract increases.
Diagnostics of alcoholic cardiomyopathy
The diagnosis of this pathology is carried out by a therapist or cardiologist. Since patients often hide the fact of alcohol abuse, if they suspect cardiomyopathy of alcoholic genesis, relatives of patients are interviewed, and if the appropriate etiology is identified, a narcologist’s consultation is prescribed to choose the optimal tactics for treating addiction. The list of diagnostic measures includes:
- Objective examination. Restless or inhibited behavior, cyanosis of the fingertips, nose, ears, upper chest may be detected. During palpation, there is increased sweating, swelling and cooling of the extremities, swelling and pulsation of the vessels of the neck. An increase in the size of the heart during percussion indicates hypertrophy or dilation of its chambers. Pathological noises characteristic of structural changes of the myocardium and valves are determined auscultatively.
- Electrocardiography. It is a basic instrumental method of research, allows to identify rhythm disturbances, to obtain data on organic myocardial damage, to assume its toxic etiology. The ECG can be supplemented with daily Holter monitoring. In the absence of contraindications, bicycle ergometry is prescribed.
- Echocardiography. EchoCG is used to assess the condition of the coronary arteries and valvular apparatus, detect myocardial hypertrophy and dilation, reduce blood flow rate, and determine pressure in the chambers. It is performed for the differential diagnosis of cardiomyopathy and pericarditis.
- Radiography of abdominal area. Chest X-rays show signs of enlargement of the chambers of the heart, less often dilation of the ascending aorta. The technique is used to clarify the condition of other large vessels, to identify pathological formations. Based on the pictures, it is possible to suspect valve defects.
Differential diagnosis of cardiomyopathy of alcoholic etiology is carried out with diseases with a similar clinical picture: angina, coronary heart disease, myocardial infarction, delaminating aortic aneurysm, pleurisy, pneumonia. Other types of cardiomyopathy are excluded: restrictive, hypertrophic, arrhythmogenic dysplasia of the right ventricle.
Treatment of alcoholic cardiomyopathy
Complex therapy of the disease includes stopping the use of ethanol-containing beverages, fighting heart failure, correcting metabolic disorders, restoring the functions of other organs. The positive effect of course treatment is possible at an early stage of the disease in the absence of irreversible disorders. In the later stages, continuous intake of medications is necessary. There are the following areas of cardiomyopathy treatment:
- Lifestyle changes. It provides for complete abstinence from alcohol, the exclusion of smoking. A diet with a large amount of protein, salt and fat restriction is prescribed. Preference is given to steamed, stewed or boiled dishes, meals are carried out in small portions 4-6 times a day. The daily fluid intake is no more than 1.5 liters. Sufficient physical activity, healthy sleep, and stress reduction are important.
- Drug therapy. It is the basis of the treatment of the disease, provides for the use of several groups of drugs that are prescribed individually, taking into account the symptoms. Antihypertensive agents are used to normalize blood pressure, antiarrhythmics are used to prevent rhythm disturbances, diuretics are used to eliminate edema, statins are used to reduce blood cholesterol. In severe cases, the treatment plan is supplemented with cardiac glycosides to relieve tachyarrhythmia attacks, antiplatelet agents and anticoagulants to prevent thromboembolic complications.
- Surgical intervention. In case of ineffectiveness of conservative therapy, rapid progression of alcoholic cardiomyopathy with a high risk of dangerous complications, the issue of heart transplantation is being considered. The method provides a high 10-year survival rate (about 75%), is used in a satisfactory state of the body, the absence of gross mental and intellectual disorders. The disadvantages of the technique are traumatism, high cost, shortage of donor organs.
Prognosis and prevention
In the early stages of the disease, provided complete abstinence from alcohol and timely initiation of treatment, the prognosis is favorable. With the development of irreversible changes in the heart muscle, there is a significant reduction in life expectancy. Prevention of cardiomyopathy is not only a medical, but also a social task, it includes measures to combat alcoholism: informing the population about the basic principles of a healthy lifestyle, limiting the advertising of alcoholic beverages and their distribution among young people at the legislative level. Preventive measures also involve informing the public about the consequences of prolonged alcohol intoxication, its effect on the heart, other organs and systems.