Alcoholic cardiomyopathy: Difference between revisions
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==Diagnosis== | ==Diagnosis== | ||
===History=== | ===History and Symptoms=== | ||
The | 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. | ||
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]]. | |||
*[[Anasarca]] or [[overall swelling]] | *[[Anasarca]] or [[overall swelling]] | ||
*[[ | *[[Anorexia]] | ||
*[[Cough]] containing mucus, or pink | *[[Cachexia]] | ||
*[[Decreased alertness]] or [[decreased concentration]] | *[[Cough]] containing mucus, or pink frothy material | ||
*[[Dyspnea]] or [[shortness of breath with activity]] | *[[Decreased alertness]] or [[decreased concentration]] | ||
*[[Dyspnea]] or [[shortness of breath with activity]] | |||
*[[Faintness]] | *[[Faintness]] | ||
*[[Fatigue]] | *[[Fatigue]] | ||
| Line 33: | Line 28: | ||
*[[Nocturia]] or a [[need to urinate at night]] | *[[Nocturia]] or a [[need to urinate at night]] | ||
*[[Oliguria]] or [[decreased urine output]] | *[[Oliguria]] or [[decreased urine output]] | ||
*[[Orthopnea]] or [[breathing difficulty while lying down]] | *[[Orthopnea]] or [[breathing difficulty while lying down]] | ||
*[[Palpitations]] | *[[Paroxysmal nocturnal dyspnea]] | ||
*[[Pedal edema]], [[ankle swelling]], [[feet swelling]], and [[leg swelling]] | *[[Palpitations]] | ||
*[[Pedal edema]], [[ankle swelling]], [[feet swelling]], and [[leg swelling]] | |||
*[[Weakness]] | *[[Weakness]] | ||
===Physical Examination=== | |||
*Enlarged [[heart]] with a laterally displaced and diffuse point of maximal impulse. | |||
*Abnormal [[heart sound]]s, third and fourth heart sounds may be heard. | |||
*Apical [[murmur]] of [[mitral regurgitation]] and the lower parasternal murmur of [[tricuspid regurgitation]] may be present secondary to papillary muscle displacement and dysfunction. | |||
*[[Jugular venous distention]], peripheral [[edema]], and [[hepatomegaly]] may be present secondary to elevated right heart pressures and right ventricular dysfunction. | |||
*Cold extremities with decreased [[pulse]]s | |||
===Electrocardiogram=== | ===Electrocardiogram=== | ||
*Reduced [[QRS voltage]] may be present | *Reduced [[QRS voltage]] may be present. | ||
*[[T wave alternans]] may be present | *[[T wave alternans]] may be present. | ||
===Chest X Ray=== | |||
===Chest X | *Chest x rays usually show evidence of [[cardiomegaly]] or [[an enlarged heart]], [[pulmonary congestion]], and [[pleural effusion]]s. | ||
*[[ | ===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. | |||
===Other Diagnostic Studies=== | |||
*[[Cardiac catheterization]] or [[angiogram]] to rule out coronary artery blockages. | |||
==Treatment== | ==Treatment== | ||
Revision as of 19:32, 23 January 2013
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Alcoholic cardiomyopathy is a disease in which the abuse 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. Excessive use of alcohol has a direct toxic effect on the heart muscle cells. The heart muscle becomes weakened 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 directly damage the liver.
Epidemiology and Demographics
Alcoholic cardiomyopathy is more prevalent in middle age males between the ages of 35-50. However, females may be more sensitive to cardiotoxic effects of alcohol.
Diagnosis
History and Symptoms
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.
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.
- Anasarca or overall swelling
- Anorexia
- Cachexia
- Cough containing mucus, or pink frothy material
- Decreased alertness or decreased concentration
- Dyspnea or shortness of breath with activity
- Faintness
- Fatigue
- Irregular pulse or rapid pulse
- Nocturia or a need to urinate at night
- Oliguria or decreased urine output
- Orthopnea or breathing difficulty while lying down
- Paroxysmal nocturnal dyspnea
- Palpitations
- Pedal edema, ankle swelling, feet swelling, and leg swelling
- Weakness
Physical Examination
- Enlarged heart with a laterally displaced and diffuse point of maximal impulse.
- Abnormal heart sounds, third and fourth heart sounds may be heard.
- Apical murmur of mitral regurgitation and the lower parasternal murmur of tricuspid regurgitation may be present secondary to papillary muscle displacement and dysfunction.
- Jugular venous distention, peripheral edema, and hepatomegaly may be present secondary to elevated right heart pressures and right ventricular dysfunction.
- Cold extremities with decreased pulses
Electrocardiogram
- Reduced QRS voltage may be present.
- T wave alternans may be present.
Chest X Ray
- Chest x rays usually show evidence of cardiomegaly or an enlarged heart, pulmonary congestion, and pleural effusions.
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.
Other Diagnostic Studies
- Cardiac catheterization or angiogram to rule out coronary artery blockages.
Treatment
Treatment for Alcoholic cardiomyopathy involves a lifestyle change as well as treatment through medication. If the heart failure is severe the effectiveness of treatment will be limited.
Medication may include, ACE inhibitors and Beta Blockers which are commonly used with other forms of cardiomyopathy to reduce the strain on the heart. The medication may include diuretics to help remove the excess liquid in the body. Persons with congestive heart failure maybe considered for surgery insert and ICD or a pacemaker which can improve the heart function. In cases where the heart failure is irreversible and declining a heart transplant maybe considered. Lifestyle changes would include an absitnance from alcohol, a low sodium diet and a reduction in the fluids consumed.
Treatment will possibly prevent the heart from deterioration but is unlikely to reverse the reduced function that has already occurred