This was an excellent result long before ACE inhibitors or betablockers were available for heart failure treatment 57. Alcoholic cardiomyopathy (ACM) is a cardiac disease caused by chronic alcohol consumption. The major risk factor for developing ACM is chronic alcohol use; however, there is no cutoff value for the amount of alcohol consumption that would lead to the development of ACM. This activity describes the pathophysiology of ACM, its causes, presentation and the role of the interprofessional team in its management.ACM is characterized by increased left ventricular mass, dilatation of the left ventricle, and heart failure (both systolic and diastolic).
- Basic research studies have described an abundance of mechanisms that could underscore the functional and structural alterations found in ACM.
- These mechanisms contribute to the development of oxidative stress, which is responsible for the onset of cardiomyopathies and ischemia-reperfusion injury.
- Ethanol-induced disruption of ribosomal protein synthesis also contributes to non-contractile protein depletion 104.
- The resulting effect in those multiple sites may be additive and synergistic, increasing the final damage 20,52 (Figure 1).
- In the Caerphilly prospective heart disease study, platelet aggregation induced by adenosine diphosphate was also inhibited in subjects who drank alcohol 99.
Alcoholic cardiomyopathy: Cytotoxicity of alcohol on heart muscle
Alcohol-induced cardiomyopathy is a condition that can have major impacts on your life over time. While many people will recover from this condition if they abstain from alcohol, others will have symptoms and related problems for the rest of their life. If you are a heavy drinker, talking to a primary care provider can help keep this condition from becoming even more severe in the future, or even prevent it from happening. Your provider is the best source of information and guidance, and they can connect you to other resources that can help and experts who can assist. In some cases, especially those that are more severe, heart failure symptoms and related conditions may develop or get worse.
2. Ethanol-induced Myocyte Apoptosis and Autophagy
Among patients who continued drinking heavily, transplant-free survival was significantly worse than in non-drinkers (27% vs 45%). Additionally, the accepted ACM definition does not take into account a patient’s sex or body mass index (BMI). As women typically have a lower BMI than men, a similar amount of alcohol would reach a woman’s heart after consuming smaller quantities of alcohol.
Potential Treatments for Affected Patients
However, cardiac apoptosis may also develop independently of the mitochondrial pathway 115 through the extrinsic pathway, which involves cell surface death receptors 116. In addition to inducing apoptosis, ethanol inhibits the effect of anti-apoptotic molecules such as BCL-2 101. Ethanol-induced myocyte apoptosis may be regulated by growth factors 117,118 and cardiomyokines 119. The percentage of apoptotic myocytes in ACM is relatively low but, in combination with a persistent decrease in myocyte proliferation, they may contribute to an absolute cell loss and decreased cardiac contractility 52,115.
- Analogous to the sarcoplasmic reticulum, the mitochondria were swollen or oedema was present, with crest alterations and intra-mitochondrial inclusions suggesting degenerative processes (Figure 2).
- An electrical current travels through your entire heart with every heartbeat, causing each part of the heart to squeeze in a specific sequence.
- This was an excellent result long before ACE inhibitors or betablockers were available for heart failure treatment 57.
- The pathophysiology of AC involves a combination of direct toxic effects of alcohol on the myocardium, oxidative stress, mitochondrial dysfunction, and genetic susceptibility.
- In fact, there is an increasing consumption in particular groups, such as adolescents and young people 3,4.
Coronary artery disease and atherosclerosis
The left ventricular end-diastolic diameters show a significant increase in such patients compared to healthy individuals in the same age and weight. Moreover, there is a decrease in the left ventricular mass index and ejection fraction, falling below the normal range. Diastolic dysfunction, characterized by impaired left ventricular relaxation and reduced diastolic filling capacity, serves as an early indicator of ACM.
How should I change my diet if I have this condition?
In long-term follow-up studies, a mortality rate of 10% of patients/year has been observed in the group of patients with persistent high-dose ethanol consumption 19,52. This ethanol misuse at high consumption rates causes a variety of health problems, ethanol being the sixth most relevant factor of global burden of disease and responsible for 5.3% of all deaths 5. Despite this clear epidemiological evidence of ethanol’s unsafe consumption and increased health risk, results of consumption policies are not effective enough. Therefore, the need to establish a more effective control on ethanol consumption has been repeatedly claimed 2.
Imaging tests like echocardiograms, chest x-rays, MRIs, and CT scans can detect changes in the heart’s shape or determine how tracers flow through the heart to determine a potential ailment. These tests, in combination with knowledge about the patient’s frequency of alcohol consumption, can lead to the diagnosis of alcoholic cardiomyopathy. Over those years, the alcohol tends to wear down the heart through temporary increases in heart rate and blood pressure. These irregularities weaken the heart muscle over time while also causing it to enlarge in order to account for its lower strength.
- Regarding ICD and CRT implantation, the same criteria as in DCM are used in ACM, although it is known that excessive alcohol intake is specifically linked to ventricular arrhythmia and sudden cardiac death71.
- These areas are more easily stretched and can be more susceptible to weakening muscles.
- Future studies in ACM should also address this topic, which has important economic consequences.
- Alcoholic cardiomyopathy (ACM) is a cardiac disease caused by chronic alcohol consumption.
- If you are a heavy drinker, talking to a primary care provider can help keep this condition from becoming even more severe in the future, or even prevent it from happening.
Health Challenges
Medications, therapy, and group support can help you decrease your alcohol consumption. Another curious hypothesis from Germany suspected that some ethanol additives, such as anti-foam beer products with arsenic or cobalt content, produced cardiac toxicity https://ecosoberhouse.com/ and development of ACM 71. Therefore, it is evident that ACM may develop with normal serum thiamine and electrolyte levels 38,66. Consumption of other drugs such as cocaine or tobacco may interact with ethanol and potentiate the final ethanol-related cardiac damage 22,72. In general, most people who stop drinking alcohol will feel better over the next three to six months.
How does this condition affect my body?
They commonly include fatigue, shortness of breath, and swelling of the legs and feet. While its causes can range from family-inherited genes to viral infections and high blood pressure, excessive alcohol alcoholic cardiomyopathy is especially dangerous because use is also among them. In the study by Gavazzi et al10, ACM patients who continued drinking exhibited worse transplant-free survival rates after 7 years than those who stopped drinking alcohol (27% vs 45%)10.