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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]]. 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]].
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| ==Epidemiology and Demographics== | | ==[[Alcoholic cardiomyopathy pathophysiology|Pathophysiology]]== |
| 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.
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| ==Diagnosis== | | ==[[Alcoholic cardiomyopathy differential diagnosis|Differentiating Alcoholic cardiomyopathy from other Diseases]]== |
| ===History and Symptoms===
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| 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]].
| | ==[[Alcoholic cardiomyopathy epidemiology and demographics|Epidemiology and Demographics]]== |
| *[[Anasarca]] or [[overall swelling]]
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| *[[Anorexia]]
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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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| *[[Faintness]]
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| *[[Fatigue]]
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| *[[Irregular pulse]] or [[rapid pulse]]
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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]], [[ankle swelling]], [[feet swelling]], and [[leg swelling]]
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| *[[Weakness]]
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| ===Physical Examination=== | |
| *Enlargment of the [[heart]] with a laterally displaced and diffused point of maximal impulse.
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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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| *[[Jugular venous distention]], peripheral [[edema]], and [[hepatomegaly]] may be present secondary to elevated right heart pressures and right ventricular dysfunction.
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| *Cold extremities with decreased [[pulse]]s.
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| * Other sequelae of [[alcoholic liver disease]] may also be noted on physical examination.
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| ===Electrocardiogram=== | | ==[[Alcoholic cardiomyopathy natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
| *Reduced [[QRS]] voltage may be present.
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| *[[T wave alternans]] may be present.
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| ===Chest X Ray=== | | ==Diagnosis== |
| *[[Chest x ray]]s usually show evidence of [[cardiomegaly]] or [[an enlarged heart]], [[pulmonary congestion]], and [[pleural effusion]]s.
| | [[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]] |
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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.
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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.
| | ==Case Studies== |
| | [[Alcoholic cardiomyopathy case study one|Case #1]] |
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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.
| | ==Related Chapters== |
| | * [[Cardiomyopathy]] |
| | * [[Dilated cardiomyopathy]] |
| | * [[Congestive heart failure]] |
| | * [[Anticoagulation in patients with dilated cardiomyopathy]] |
| | * [[First degree AV block]] |
| | * [[Second degree AV block]] |
| | * [[Beriberi heart disease]] |
| | * [[Alcoholic liver disease]] |
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| ==Related Chapters==
| | {{WH}} |
| *[[Cardiomyopathy]]
| | {{WS}} |
| *[[Dilated cardiomyopathy]]
| | [[CME Category::Cardiology]] |
| *[[Congestive heart failure]]
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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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