Thus, although there is a certain degree of consensus regarding the recommendation of full alcohol withdrawal in ACM, it is yet to be resolved whether moderate alcohol consumption is sufficient to achieve an improvement in the prognosis of these patients. Finally, it is worth stressing that a large majority of studies on the physiopathology and prognosis of ACM were conducted some years ago, prior to the development of our current understanding regarding the role of genetics in DCM[67]. According to recent data, a genetic form of DCM could be present in up to 50% of idiopathic DCM cases, and other specific alcoholic cardiomyopathy is especially dangerous because forms of DCM such as peripartum cardiomyopathy have been shown to have a genetic basis in a significant number of cases[68]. It is therefore possible that patients with ACM could also harbour a genetic substrate that predisposes them to this form of cardiomyopathy. 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. The primary treatment for ACM involves complete abstinence from alcohol or other drugs.
Is this condition only a chronic (long-term) problem?
In spite of the high prevalence of excessive alcohol consumption and of its consideration as one of the main causes of DCM, only a small number of studies have analysed the long-term natural history of ACM. Unfortunately, all the available reports were completed at a time when a majority of the current heart failure therapies were not available (Table (Table11). Unfortunately Lazarević et al[23], as in most of these studies, systematically excluded patients with a history of heart disease or with HF symptoms. It is therefore possible that most of these studies may have also consistently omitted most alcohol abusers in whom alcohol had already caused significant ventricular dysfunction. One relevant question concerning ethanol cardiac toxicity is if ethanol itself or its active metabolite acetaldehyde causes cardiac damage [73,74]. In fact, both molecules are directly cardiotoxic, decreasing structural protein synthesis and heart contractility and increasing oxidative and metabolic damage, leading to autophagy [20,75].
Beriberi heart disease
- While some consider that this toxin alone is able to cause such a disease[18,19], others contend that it is just a trigger or an agent favouring DCM[3,21,22].
- In the course of ethanol-induced cardiac damage, one of the more relevant findings is that ethanol exerts its deleterious effects on cardiac myocytes at multiples sites (membrane, receptors, mitochondria, ribosomes, sarcolemma, DNA, or cytoskeleton) [18,19,98] (Table 1).
- Alcoholism is an important cause of DCM.20 The clinical diagnosis of alcoholic cardiomyopathy is suspected when biventricular dysfunction and dilation are noted in an individual with a long and heavy alcohol abuse history, in the absence of other known causes for myocardial disease.
- In cases where people don’t recover fully by abstaining from alcohol, most people will still see noticeable improvements in their symptoms.
- For many people, abstaining from alcohol can lead to a full recovery, especially when your case is less severe.
- This can cause various symptoms, including shortness of breath, fluid retention, and fainting.
If it takes too long — even by tiny fractions of a second— that delay can cause your heart to beat out of sync (a problem called dyssynchrony). Similarly, alcohol can have a toxic effect on your heart and cause scar tissue to form. That scar tissue can also cause potentially life-threatening arrhythmias (irregular heart rhythms). The muscles that control the lower chambers of your heart, the left and right ventricle, are especially prone to this kind of stretching. These chambers are important as they do the majority of the work of your heart, with the right ventricle pumping blood to your lungs and the left ventricle pumping blood to your entire body.
International Patients
- Even in cases where people can undergo a heart transplant, individuals with a history of alcohol-induced cardiomyopathy are more likely to face other health problems down the road.
- Thus, alcohol-dilated cardiomyopathy (ACM) is the result of dosage and individual predisposition [32].
- Ultimately, your body can’t keep up with the damage to multiple organ systems, including your heart.
This was interpreted by the authors as suggesting that acetaldehyde plays a key role in the cardiac dysfunction seen after alcohol intake. Others have suggested that an acute decrease in mitochondrial glutathione content may play a role in mitochondrial damage and implicate oxidative https://ecosoberhouse.com/article/how-to-write-a-goodbye-letter-to-addiction/ stress as a contributor in this process. During the first half of the 20th century, the concept of beriberi heart disease (ie, thiamine deficiency) was present throughout the medical literature, and the idea that alcohol had any direct effect on the myocardium was doubted.
Laboratory Studies
Differential Diagnosis
- In the mid-1960s, another unexpected heart failure epidemic among chronic, heavy beer drinkers occurred in two cities in the USA, in Quebec, Canada, and in Belgium.
- Let your healthcare professional know if you have a family history of the condition.
- Transplant-free survival after 7 years was worse among patients with ACM than among those with DCM (41% vs 53%).
- In addition to these, stem-cell therapy tries to improve myocyte regeneration [112,152].