Alcoholic cardiomyopathy: Difference between revisions
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*Abnormal [[heart sound]]s, namely third [[S3]] and fourth [[S4]] sounds may be heard. | *Abnormal [[heart sound]]s, namely third [[S3]] and fourth [[S4]] 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. | *Apical [[murmur]] of [[mitral regurgitation]] and the lower parasternal murmur of [[tricuspid regurgitation]] may be present secondary to papillary muscle displacement and dysfunction. | ||
* [[Rales]] may be heard on lung exam due to pulmonary congestion. | |||
*[[Jugular venous distention]], peripheral [[edema]], and [[hepatomegaly]] may be present secondary to elevated right heart pressures and right ventricular 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. | *Cold extremities with decreased [[pulse]]s. | ||
Revision as of 14:41, 27 January 2013
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Hardik Patel, M.D.
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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. 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.
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.
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
- Enlargment of the heart with a laterally displaced and diffused point of maximal impulse.
- Abnormal heart sounds, namely third S3 and fourth S4 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.
- Rales may be heard on lung exam due to pulmonary congestion.
- 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.
- Other sequelae of alcoholic liver disease may also be noted on physical examination.
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 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.
Medications may include, ACE inhibitors and beta blockers which are commonly used for other forms of cardiomyopathy to reduce the strain on the heart. Diuretics 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.
Treatment will possibly prevent the heart from further deterioration, and the cardiomyopathy is largely reversible if complete abstinence from alcohol is maintained.