Cardiomyopathy Alcholic

The term cardiomyopathy relates to the pathogenesis of the myocardium, the tissue of the heart. Consuming alcohol in large volumes has a toxic effect on heart, it deteriorates the function of the myocardium and makes it vulnerable to heart muscle diseases like arrhythmia or sudden cardiac death. Actually, theoretically the term cardiomyopathy refers to  any disease affecting the heart, but practically the term is usually reserved for severe  and acute myocardial disease leading to heart failure. If excessive intake of alcohol is continued for a long period the heart becomes enlarged and the muscle thins and therefore cannot pump blood efficiently. Due to a deficient flow of blood all the body parts get affected and in severe cases many tissues and organs undergo an irrevocable damage. Cardiomyopathy due to alcohol is a gradual process and can often go undetected, making it especially dangerous to carriers of the disease.

 Constant observations reflect that, for over a period of 150 years consumption of alcohol has been associated with the occurrence of a variety of cardiovascular diseases. Reports show that consumption of heavy amounts of alcohol are deleterious for one's health and are instrumental in cardiac enlargement and heart failure. Earlier several observations led to different schools of thoughts which also claimed that alcohol did not have a direct toxic effect on the myocardium. But then researches conducted in last 25 years have shown that consumption of alcohol is a precursor of cardiomyopathy. Alcoholic cardiomyopathy is most commonly seen in men ages 35-55. However, it may develop in anyone who drinks too much alcohol over a long period of time.

 Based on their origin, cardiomyopathies have been categorized as extrinsic or intrinsic.

Generally cardiomyopathies fall in this category. In extrinsic cardiomyopathy the pathology is found outside the myocardium itself. Ischemia is the most common cause of extrinsic cardiomyopathy. Ischemic cardiomyopathy is a clinical condition which develops due to an inadequate supply of oxygen to the myocardium but it occurs due degenerative coronary artery diseases. Types of Secondary/extrinsic cardiomyopathies are  

Metabolism/storage related cardiomyopathies like amyloidosis, hemochromatosis

Inflammation related cardiomyopathies like Chagas disease

Endocrine system linked cardiomyopathies like diabetic cardiomyopathy, hyperthyroidism, acromegaly.

Toxicity induced cardiomyopathies like chemotherapy, Alcoholic cardiomyopathy.

Nueromuscular disorders leading to cardiomyopathy like muscular dystrophy

And other nutrient associated cardiomyopathies.

In intrinsic cardiomyopathy weakness of the myocardium, the muscle of the heart occurs which is not due to an identifiable external cause. But now a variety of disease states related with intrinsic cardiomyopathy have been associated with specific external causes. Many external causes like drug, alcohol toxicity, certain infections like hepatitis C and various genetic and idiopathic causes have been linked with intrinsic cardiomyopathy. Types of Primary/intrinsic cardiomyopathies are

 Genetic cardiomyopathies like Hypertrophic cardiomyopathy, Arrhythmogenic right ventricular cardiomyopathy, Isolted ventricular non-compaction, Mitochondrial myopathy

Mixed myopathies like Dialated cardiomyopathy, Restrictive cardiomyopathy,

Acquired myopathies like Takotsubo cardiomyopathy,Loeffler endocarditis\

Exact causation of Alcoholic cardiomyopathy is not fully understood. It was initially thought that alcohol causes cardiomyopathy through dietary deficiencies but later it was made clear that cardiomyopathy does not occur due to malnutrition and alcohol consumption can cause cardiomyopathy directly or indirectly. Several mechanisms of injury during Alcholic cardiomyopathy have been proposed which include inhibition of protein synthesis, inhibition of oxidative phosphorylation, fatty acid ester accumulation, free radical damage, inhibition of calcium-myofilament interaction, inflammatory and immunologic factors, receptor abnormalities, disruption of cell membrane structure, coronary vasospasm, synergy with concomitant conditions, activation of the renin-angiotensin system.

The disease is not manifested in form of symptoms until it aggravates and reaches an advanced stage. The symptoms which occur  at an advanced stage include ankle, feet and leg swelling, paroxysmal nocturnal dyspnea (awakening during the night due to shortness of breath), difficulty in breathing while lying down, cough containing mucus or pink frothy material, decreased alertness or mental concentration, irregular and rapid pulse, loss of appetite, fatigue, faintness, weakness ,nocturia (need to urinate at night),overall swelling, increased palpations, shortness of breath(dyspnea)

The clinical diagnosis of alcoholic cardiomyopathy is made on account of history of excessive alcohol intake and a spectrum of other  signs like abnormal heart sounds, irregular lung sounds, enlarged liver, low blood pressure, murmurs, swollen neck veins, unexplained weight gain. Apart from them  certain physical signs of alcohol abuse like parotid disease, telangiectasia or spider angiomata, mental status changes, cirrhosis, heart failure also support the existence of the ailment.

Different tests are performed which reveal the presence of the ailment and eventually a heart failure. Echocardiogram during which the sound waves are used may show enlarged heart chambers, leaking valves, or reduced pumping efficiency. Electrocardiogram may also show rhythmic abnormalities (arrhythmias) and enlarged heart chambers. Coronary angiography and cardiac catheterization is done to exclude coronary artery blockages as the cause of cardiomyopathy. X-ray of the thoracic cavity may also show heart enlargement, fluid build up in the lungs and valves, and reduced pumping function. Also the amount of hormone B-type natriuretic peptide are measured by a test.

Treatment of alcoholic cardiomyopathy involves the following procedures. Heart failure may be treated with ACE inhibitors, Beta blockers, Diuretics (furosemide and spironolactone). An implantable defibrillator (ICD) may help  a patient live longer in case of acute cases and severely weakened pumping .Sometimes implantation of  biventricular pace maker could also improve the quality of life. Even a single device which is a combination of a biventricular pacemaker and an ICD may also be recommended by the health care provider. In case, cardiomyopathy is not reversible then a heart transplant is administered. Changes in the nutritional intake may also be recommended. The patient must be placed on a low salt diet. The amount of drinks especially alcohol should be monitored and in chronic cases a complete check should be imposed. Nutritional deficiencies pertaining to thiamine, phosphorus, potassium, or magnesium levels are should also be met.

Certain life style changes if incorporated can aid in prevention from the disease. People who fall prey to alcoholic cardiomyopathy consume excessive amount of alcohol against the recommended standards. The recommended maximum levels of alcohol consumption for women and men in the United States are 7 drinks (14 units) and 14 drinks (28 units) per week, respectively. In the United Kingdom, the limit for men is the same (28 units) but for women it is higher at 21 units. Keeping obesity at bay, exercising regularly, avoiding smoking and having a well-balanced, nutritious diet can help one control the risk factors for a heart disease.

Since relation between alcohol consumption and cardiomyopathy has been established one must watch the amount of alcohol intake .If the disease is diagnosed early then further alcohol intake should be reduced or halted .Heavy amounts of alcohol are not only injurious for heart but also liver and is the key cause of liver cirrhosis.