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| {{SI}} | | {{Alcoholic cardiomyopathy}} |
| {{CMG}}; {{AE}} {{HP}} | | {{CMG}}; {{AE}} {{RT}}; {{HP}} |
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| | '''For patient information, click [[Dilated cardiomyopathy (patient information)|here]]''' |
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| ==Overview== | | ==[[Alcoholic cardiomyopathy overview|Overview]]== |
| Alcoholic cardiomyopathy is a disease in which the excessive use of [[alcohol]] use damages the [[heart muscle]] causing [[heart failure]]. It is characterized by constellation of findings which includes a history of excessive alcohol intake, physical signs of [[alcohol]] abuse, [[heart failure]], and supportive findings consistent with [[dilated cardiomyopathy]].
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| ==Pathophysiology== | | ==[[Alcoholic cardiomyopathy historical perspective|Historical Perspective]]== |
| Alcoholic cardiomyopathy is a type of [[dilated cardiomyopathy]]. Both acute and chronic alcohol consumption, in excessive amounts, has been associated with adverse effects on the myocardium leading to nonischemic dilated cardiomyopathy. The maximum recommended dose of alcohol consumption in US men and women is 14 drinks and 7 drinks respectively. Consumption above these levels has been shown to be associated with the increased risk of alcoholic cardiomyopathy. <ref name="pmid9392695">{{cite journal |author=Thun MJ, Peto R, Lopez AD, ''et al.'' |title=Alcohol consumption and mortality among middle-aged and elderly U.S. adults |journal=[[The New England Journal of Medicine]] |volume=337 |issue=24 |pages=1705–14|year=1997 |month=December |pmid=9392695 |doi=10.1056/NEJM199712113372401 |url=}}</ref>
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| Excessive use of [[alcohol]] has a direct toxic effect on the [[heart muscle]] cells. The heart muscle becomes weakened, subsequently dilates, and cannot pump [[blood]] efficiently. The lack of [[blood flow]] affects all parts of the body, resulting in damage to multiple tissues and organ systems. Alcohol may also simultaneously be causing direct damage to the [[liver]].<ref name="pmid12006456">{{cite journal |author=Piano MR |title=Alcoholic cardiomyopathy: incidence, clinical characteristics, and pathophysiology |journal=[[Chest]] |volume=121 |issue=5 |pages=1638–50 |year=2002 |month=May |pmid=12006456 |doi= |url=}}</ref>.
| | ==[[Alcoholic cardiomyopathy pathophysiology|Pathophysiology]]== |
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| Proposed mechanisms of myocardial injury in alcoholic cardiomyopathy include:
| | ==[[Alcoholic cardiomyopathy differential diagnosis|Differentiating Alcoholic cardiomyopathy from other Diseases]]== |
| * Ethanol induced apoptosis
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| * Impaired contraction of myocardium due to direct toxicity
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| * Inhibition of protein synthesis
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| * Activation of renin-angiotensin system (RAS)
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| * Inhibition of oxidative phosphorylation
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| * Fatty acid ester accumulation
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| * Nutritional deficiency of [[thiamine]]
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| * Free radical damage
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| ==Epidemiology and Demographics== | | ==[[Alcoholic cardiomyopathy epidemiology and demographics|Epidemiology and Demographics]]== |
| Alcoholic cardiomyopathy is more prevalent in middle aged males between the ages of 35-50. However, females may be more sensitive to cardiotoxic effects of alcohol, and may develop alcoholic cardiomyopathy with lesser amounts of alcohol use, than males. | | |
| | ==[[Alcoholic cardiomyopathy natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
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| ==Diagnosis== | | ==Diagnosis== |
| ===History and Symptoms===
| | [[Alcoholic cardiomyopathy history and symptoms|History and Symptoms ]] | [[ Alcoholic cardiomyopathy physical examination|Physical Examination]] | [[Alcoholic cardiomyopathy laboratory findings|Laboratory Findings]] | [[Alcoholic cardiomyopathy electrocardiogram|Electrocardiogram]] | [[Alcoholic cardiomyopathy chest x ray|Chest X Ray]] | [[Alcoholic cardiomyopathy echocardiography|Echocardiography]] | [[Alcoholic cardiomyopathy other imaging findings|Other Imaging Findings]] | [[Alcoholic cardiomyopathy other diagnostic studies|Other Diagnostic Studies]] |
| The [[alcohol]] history, with attention to daily, maximal, and lifetime intake and the duration of [[alcohol]] consumption as well as the nutritional status of the patient should be inquired about.
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| Symptoms presented by the occurrence of alcoholic cardiomyopathy are the result of the [[heart failure]] and usually occur after the disease has progressed to an advanced stage. Therefore the symptoms have a lot in common with other forms of [[cardiomyopathy]]. Symptoms may develop acutely or insidiously. | |
| *[[Anasarca]] or [[overall swelling]]
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| *[[Anorexia]]
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| *[[Arrhythmias]]
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| *[[Cachexia]]
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| *[[Cough]] containing mucus, or pink frothy material
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| *[[Decreased alertness]] or [[decreased concentration]]
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| *[[Dyspnea]] or [[shortness of breath with activity]]
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| *[[Fatigue]]
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| *[[Nocturia]] or a [[need to urinate at night]]
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| *[[Oliguria]] or [[decreased urine output]]
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| *[[Orthopnea]] or [[breathing difficulty while lying down]]
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| *[[Paroxysmal nocturnal dyspnea]]
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| *[[Palpitations]]
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| *[[Pedal edema]]
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| *[[Syncope]]
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| *[[Weakness]]
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| ===Physical Examination===
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| ====Appearance of the Patient====
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| The patient may have altered mental status due to chronic alcoholism.
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| ====Neck====
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| * [[Jugular venous distension]] may be seen in the presence of [[right heart failure]]
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| ====Extremities====
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| * Pedal edema
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| * Cold extremities with decreased pulse
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| ====Lungs====
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| * [[Rales]] may be heard on lung exam due to pulmonary congestion.
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| ====Heart====
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| =====Palpitation=====
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| * Enlargment of the [[heart]] with a laterally displaced and diffused point of maximal impulse.
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| =====Auscultation=====
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| * Abnormal [[heart sound]]s, namely third [[S3]] and fourth [[S4]] sounds may be heard.
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| * Apical [[murmur]] of [[mitral regurgitation]] and the lower parasternal murmur of [[tricuspid regurgitation]] may be present secondary to papillary muscle displacement and dysfunction.
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| ====Abdomen====
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| * [[Hepatomegaly]]
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| * [[Ascites]]
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| Other sequelae of [[alcoholic liver disease]] may also be noted on physical examination.
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| * [[Telangiectasia]]
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| * [[Spider angiomata]]
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| ===Electrocardiogram===
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| *Reduced [[QRS]] voltage may be present.
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| *[[T wave alternans]] may be present.
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| ===Chest X Ray===
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| *[[Chest x ray]]s usually show evidence of [[cardiomegaly]] or [[an enlarged heart]], [[pulmonary congestion]], and [[pleural effusion]]s.
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| ===Echocardiography===
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| * [[Echocardiography]] is the most useful initial diagnostic test in the evaluation of patients with [[heart failure]]. Because of its noninvasive nature and the ease of the test, it is the test of choice in the initial and follow-up evaluation of most forms of [[cardiomyopathy]]. It provides information not only on overall heart size and function, but also on valvular structure and function, wall motion and thickness, and pericardial disease. Possible echocardiographic findings include: <ref name="pmid6450342">{{cite journal |author=Orlando E, Gennari P, Boari C |title=[Echocardiographic study of the left ventricle in chronic alcoholism] |language=Italian |journal=[[Minerva Medica]] |volume=71 |issue=44 |pages=3235–9 |year=1980 |month=November |pmid=6450342 |doi= |url=}}</ref>
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| * LV dilatation (earliest manifestation)
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| * Increased LV wall thickness <ref name="pmid6444262">{{cite journal |author=Askanas A, Udoshi M, Sadjadi SA |title=The heart in chronic alcoholism: a noninvasive study |journal=[[American Heart Journal]] |volume=99 |issue=1 |pages=9–16 |year=1980 |month=January |pmid=6444262 |doi= |url=}}</ref>
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| * [[diastolic dysfunction|Diastolic]] and [[systolic dysfunction]]<ref name="pmid11141042">{{cite journal |author=Fernández-Solà J, Nicolás JM, Paré JC, ''et al.'' |title=Diastolic function impairment in alcoholics |journal=[[Alcoholism, Clinical and Experimental Research]] |volume=24 |issue=12 |pages=1830–5 |year=2000 |month=December |pmid=11141042 |doi= |url=}}</ref><ref name="pmid7635421">{{cite journal |author=Estruch R, Fernández-Solá J, Sacanella E, Paré C, Rubin E, Urbano-Márquez A |title=Relationship between cardiomyopathy and liver disease in chronic alcoholism |journal=[[Hepatology (Baltimore, Md.)]] |volume=22 |issue=2 |pages=532–8 |year=1995 |month=August |pmid=7635421 |doi= |url=}}</ref>
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| * Reduced [[ejection fraction]] <ref name="pmid6486037">{{cite journal |author=Kelbaek H, Eriksen J, Brynjolf I, ''et al.'' |title=Cardiac performance in patients with asymptomatic alcoholic cirrhosis of the liver |journal=[[The American Journal of Cardiology]] |volume=54 |issue=7 |pages=852–5 |year=1984 |month=October |pmid=6486037 |doi= |url=}}</ref><ref name="pmid2860335">{{cite journal |author=Dancy M, Bland JM, Leech G, Gaitonde MK, Maxwell JD |title=Preclinical left ventricular abnormalities in alcoholics are independent of nutritional status, cirrhosis, and cigarette smoking |journal=[[Lancet]] |volume=1 |issue=8438 |pages=1122–5 |year=1985 |month=May |pmid=2860335 |doi= |url=}}</ref>
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| ===Other Diagnostic Studies===
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| *[[Cardiac catheterization]] or [[angiogram]] to rule out coronary artery blockages.
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| ==Treatment== | | ==Treatment== |
| Treatment for alcoholic cardiomyopathy involves lifestyle changes, including complete abstinence from [[alcohol]] use, a low sodium diet, and fluid restriction, as well as medications. If the [[heart failure]] is severe, the effectiveness of treatment will be limited.
| | [[Alcoholic cardiomyopathy medical therapy|Medical Therapy]] | [[Alcoholic cardiomyopathy surgery |Surgery]] | [[Alcoholic cardiomyopathy primary prevention|Primary Prevention]] |[[Alcoholic cardiomyopathy secondary prevention|Secondary Prevention]] | [[Alcoholic cardiomyopathy cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Alcoholic cardiomyopathy future or investigational therapies|Future or Investigational Therapies]] |
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| Medications may include, [[ACE inhibitors]] and [[beta blockers]] which are commonly used for other forms of [[cardiomyopathy]] to reduce the strain on the [[heart]]. [[Diuretic]]s can also be used to help remove the excess fluid from the body. Persons with [[congestive heart failure]] may be considered for surgical insertion of an [[ICD]] or a [[pacemaker]] which can improve the heart function. In cases where the [[heart failure]] is irreversible and worsening, a [[heart transplant]] may be considered.
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| Treatment will possibly prevent the [[heart]] from further deterioration, and the [[cardiomyopathy]] is largely reversible if complete abstinence from [[alcohol]] is maintained.
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| ==References== | | ==Case Studies== |
| {{Reflist|2}}
| | [[Alcoholic cardiomyopathy case study one|Case #1]] |
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| ==Related Chapters== | | ==Related Chapters== |
| *[[Cardiomyopathy]] | | * [[Cardiomyopathy]] |
| *[[Dilated cardiomyopathy]] | | * [[Dilated cardiomyopathy]] |
| *[[Congestive heart failure]] | | * [[Congestive heart failure]] |
| * [[Anticoagulation in patients with dilated cardiomyopathy]] | | * [[Anticoagulation in patients with dilated cardiomyopathy]] |
| * [[First degree AV block]] | | * [[First degree AV block]] |
| * [[Second degree AV block]] | | * [[Second degree AV block]] |
| * [[Beriberi heart disease]] | | * [[Beriberi heart disease]] |
| *[[Alcoholic liver disease]] | | * [[Alcoholic liver disease]] |
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| | {{WH}} |
| | {{WS}} |
| | [[CME Category::Cardiology]] |
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| [[Category:Needs content]]
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| [[Category:Disease]] | | [[Category:Disease]] |
| [[Category:Cardiology]] | | [[Category:Cardiology]] |
| [[Category:Up-To-Date cardiology]]
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| [[Category:Up-To-Date]]
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| {{WH}}
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| {{WS}}
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