Alcoholic cardiomyopathy overview: Difference between revisions
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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]]. | 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]]. | ||
==Pathophysiology== | ===Pathophysiology=== | ||
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 non-ischemic dilated cardiomyopathy. It accounts for 21-36% of all cases of non-ischemic dilated cardiomyopathy <ref name="pmid18034302">{{cite journal |author=Skotzko CE, Vrinceanu A, Krueger L, Freudenberger R |title=Alcohol use and congestive heart failure: incidence, importance, and approaches to improved history taking |journal=[[Heart Failure Reviews]] |volume=14 |issue=1 |pages=51–5 |year=2009 |month=March |pmid=18034302|doi=10.1007/s10741-007-9048-8 |url=}}</ref>. 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>. Pathogenesis of this condition is multi-factorial. | 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 non-ischemic dilated cardiomyopathy. It accounts for 21-36% of all cases of non-ischemic dilated cardiomyopathy <ref name="pmid18034302">{{cite journal |author=Skotzko CE, Vrinceanu A, Krueger L, Freudenberger R |title=Alcohol use and congestive heart failure: incidence, importance, and approaches to improved history taking |journal=[[Heart Failure Reviews]] |volume=14 |issue=1 |pages=51–5 |year=2009 |month=March |pmid=18034302|doi=10.1007/s10741-007-9048-8 |url=}}</ref>. 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>. Pathogenesis of this condition is multi-factorial. | ||
===Differentiating Alcoholic Cardiomyopathy from Other Diseases=== | |||
Alcoholic cardiomyopathy is a form of dilated cardiomyopathy (DCM). Therefore, it must be differentiated from other forms of DCM like idiopathic DCM, connective tissue disorders etc. | |||
===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.<ref name="pmid9285662">{{cite journal |author=Fernández-Solà J, Estruch R, Nicolás JM, ''et al.'' |title=Comparison of alcoholic cardiomyopathy in women versus men |journal=[[The American Journal of Cardiology]] |volume=80|issue=4 |pages=481–5 |year=1997 |month=August |pmid=9285662 |doi= |url=}}</ref><ref name="pmid7596003">{{cite journal |author=Urbano-Márquez A, Estruch R, Fernández-Solá J, Nicolás JM, Paré JC, Rubin E |title=The greater risk of alcoholic cardiomyopathy and myopathy in women compared with men |journal=[[JAMA : the Journal of the American Medical Association]] |volume=274 |issue=2 |pages=149–54 |year=1995 |month=July |pmid=7596003 |doi= |url=}}</ref> | |||
===Natural History, Complications and Prognosis=== | |||
In patients who continue to abuse alcohol, 4 year survival rate is 50%. On the contrary, abstinence is associated with regression of symptoms and overall improvement. Improvement in cardiac function evident from echocardiographic findings can also be noted. | |||
==Diagnosis== | |||
===History and Symptoms=== | |||
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. | |||
===Physical Examination=== | |||
Patients with alcoholic cardiomyopathy present with signs similar to that of heart failure. Most common findings include pedal edema, increased jugular venous pressure, [[pulmonary edema]], and abnormal heart sounds. | |||
===Laboratory Findings=== | |||
Alcoholic cardiomyopathy is majorly a clinical and echocardiographic diagnosis. There are no pathognomonic laboratory findings diagnostic of this disorder. | |||
===Electrocardiogram=== | |||
Although many EKG changes are seen in patients with alcoholic cardiomyopathy, none of them are pathognomonic for this condition. However, acute alcoholic intoxication is also associated with pathological EKG changes. Common EKG abnormalities in alcoholic cardiomyopathy include non-specific ST-T changes and QT abnormalities. | |||
===Imaging=== | |||
====Chest X-ray==== | |||
Chest X-ray findings are essentially the same as those seen in [[congestive heart failure]]. | |||
====Echocardiography==== | |||
[[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. | |||
====Cardiac Catheterization==== | |||
[[Cardiac catheterization]] or [[angiogram]] may be done to rule out coronary artery disease (CAD) as the etiology of [[heart failure]] in alcoholic cardiomyopathy. In addition to ruling out [[CAD]], cardiac catheteriation may also be helpful to assess [[cardiac output]], cardiac hemodynamics and filling pressures. | |||
==Treatment== | |||
===Medical Therapy=== | |||
Treatment for alcoholic cardiomyopathy involves lifestyle changes, including complete abstinence from [[alcohol]] use <ref name="pmid9164905">{{cite journal|author=Guillo P, Mansourati J, Maheu B, ''et al.'' |title=Long-term prognosis in patients with alcoholic cardiomyopathy and severe heart failure after total abstinence |journal=[[The American Journal of Cardiology]] |volume=79 |issue=9 |pages=1276–8 |year=1997 |month=May |pmid=9164905 |doi= |url=}}</ref><ref name="pmid2131353">{{cite journal |author=Masani F, Kato H, Sasagawa Y, ''et al.'' |title=[An echocardiographic study of alcoholic cardiomyopathy after total abstinence] |language=Japanese |journal=[[Journal of Cardiology]] |volume=20 |issue=3 |pages=627–34 |year=1990 |pmid=2131353 |doi= |url=}}</ref><ref name="pmid3530014">{{cite journal |author=Agatston AS, Snow ME, Samet P |title=Regression of severe alcoholic cardiomyopathy after abstinence of 10 weeks|journal=[[Alcoholism, Clinical and Experimental Research]] |volume=10 |issue=4 |pages=386–7 |year=1986 |month=August |pmid=3530014 |doi= |url=}}</ref><ref name="pmid2125195">{{cite journal |author=Mansourati J, Forneiro I, Genet L, Le Pichon J, Blanc JJ |title=[Regression of dilated cardiomyopathy in a chronic alcoholic patient after abstinence from alcohol] |language=French |journal=[[Archives Des Maladies Du Coeur Et Des Vaisseaux]] |volume=83 |issue=12|pages=1849–52; discussion 1853 |year=1990 |month=November |pmid=2125195 |doi= |url=}}</ref>, a low sodium diet, and fluid restriction, as well as medications. If the [[heart failure]] is severe, the effectiveness of treatment will be limited. | |||
===Surgery=== | |||
In severe or unresponsive patients, [[cardiac transplantation]] can be an option. | |||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
{{WH}} | |||
{{WS}} | |||
[[CME Category::Cardiology]] | |||
[[Category:Disease]] | [[Category:Disease]] | ||
[[Category:Cardiology]] | [[Category:Cardiology]] | ||
Latest revision as of 19:48, 14 March 2016
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Raviteja Guddeti, M.B.B.S. [2]; Hardik Patel, M.D.
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.
Pathophysiology
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 non-ischemic dilated cardiomyopathy. It accounts for 21-36% of all cases of non-ischemic dilated cardiomyopathy [1]. 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 [2]. Pathogenesis of this condition is multi-factorial.
Differentiating Alcoholic Cardiomyopathy from Other Diseases
Alcoholic cardiomyopathy is a form of dilated cardiomyopathy (DCM). Therefore, it must be differentiated from other forms of DCM like idiopathic DCM, connective tissue disorders etc.
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.[3][4]
Natural History, Complications and Prognosis
In patients who continue to abuse alcohol, 4 year survival rate is 50%. On the contrary, abstinence is associated with regression of symptoms and overall improvement. Improvement in cardiac function evident from echocardiographic findings can also be noted.
Diagnosis
History and Symptoms
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.
Physical Examination
Patients with alcoholic cardiomyopathy present with signs similar to that of heart failure. Most common findings include pedal edema, increased jugular venous pressure, pulmonary edema, and abnormal heart sounds.
Laboratory Findings
Alcoholic cardiomyopathy is majorly a clinical and echocardiographic diagnosis. There are no pathognomonic laboratory findings diagnostic of this disorder.
Electrocardiogram
Although many EKG changes are seen in patients with alcoholic cardiomyopathy, none of them are pathognomonic for this condition. However, acute alcoholic intoxication is also associated with pathological EKG changes. Common EKG abnormalities in alcoholic cardiomyopathy include non-specific ST-T changes and QT abnormalities.
Imaging
Chest X-ray
Chest X-ray findings are essentially the same as those seen in congestive heart failure.
Echocardiography
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.
Cardiac Catheterization
Cardiac catheterization or angiogram may be done to rule out coronary artery disease (CAD) as the etiology of heart failure in alcoholic cardiomyopathy. In addition to ruling out CAD, cardiac catheteriation may also be helpful to assess cardiac output, cardiac hemodynamics and filling pressures.
Treatment
Medical Therapy
Treatment for alcoholic cardiomyopathy involves lifestyle changes, including complete abstinence from alcohol use [5][6][7][8], a low sodium diet, and fluid restriction, as well as medications. If the heart failure is severe, the effectiveness of treatment will be limited.
Surgery
In severe or unresponsive patients, cardiac transplantation can be an option.
References
- ↑ Skotzko CE, Vrinceanu A, Krueger L, Freudenberger R (2009). "Alcohol use and congestive heart failure: incidence, importance, and approaches to improved history taking". Heart Failure Reviews. 14 (1): 51–5. doi:10.1007/s10741-007-9048-8. PMID 18034302. Unknown parameter
|month=ignored (help) - ↑ Thun MJ, Peto R, Lopez AD; et al. (1997). "Alcohol consumption and mortality among middle-aged and elderly U.S. adults". The New England Journal of Medicine. 337 (24): 1705–14. doi:10.1056/NEJM199712113372401. PMID 9392695. Unknown parameter
|month=ignored (help) - ↑ Fernández-Solà J, Estruch R, Nicolás JM; et al. (1997). "Comparison of alcoholic cardiomyopathy in women versus men". The American Journal of Cardiology. 80 (4): 481–5. PMID 9285662. Unknown parameter
|month=ignored (help) - ↑ Urbano-Márquez A, Estruch R, Fernández-Solá J, Nicolás JM, Paré JC, Rubin E (1995). "The greater risk of alcoholic cardiomyopathy and myopathy in women compared with men". JAMA : the Journal of the American Medical Association. 274 (2): 149–54. PMID 7596003. Unknown parameter
|month=ignored (help) - ↑ Guillo P, Mansourati J, Maheu B; et al. (1997). "Long-term prognosis in patients with alcoholic cardiomyopathy and severe heart failure after total abstinence". The American Journal of Cardiology. 79 (9): 1276–8. PMID 9164905. Unknown parameter
|month=ignored (help) - ↑ Masani F, Kato H, Sasagawa Y; et al. (1990). "[An echocardiographic study of alcoholic cardiomyopathy after total abstinence]". Journal of Cardiology (in Japanese). 20 (3): 627–34. PMID 2131353.
- ↑ Agatston AS, Snow ME, Samet P (1986). "Regression of severe alcoholic cardiomyopathy after abstinence of 10 weeks". Alcoholism, Clinical and Experimental Research. 10 (4): 386–7. PMID 3530014. Unknown parameter
|month=ignored (help) - ↑ Mansourati J, Forneiro I, Genet L, Le Pichon J, Blanc JJ (1990). "[Regression of dilated cardiomyopathy in a chronic alcoholic patient after abstinence from alcohol]". Archives Des Maladies Du Coeur Et Des Vaisseaux (in French). 83 (12): 1849–52, discussion 1853. PMID 2125195. Unknown parameter
|month=ignored (help)