These authors found a relationship between the reduction or cessation of alcohol consumption and higher survival rates without a heart transplant. Guillo et al17 in 1997 described the evolution of 9 ACM patients who had been admitted. He divided this cohort into two groups according to the evolution of the ejection fraction during 36 mo in which no deaths were recorded. The 6 subjects who experienced a clear improvement in their alcohol cardiomyopathy symptoms ejection fraction had fully refrained from drinking.
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Enlarged heart, in heart failure
Therefore, the need to establish a more effective control on ethanol consumption has been repeatedly claimed 2. The mainstay of therapy for alcoholic cardiomyopathy (AC) is to treat the underlying cause, ie, to have the patient exercise complete and perpetual abstinence from all alcohol consumption. The efficacy of abstinence has been shown in persons with early disease (eg, prior to the onset of severe myocardial fibrosis) and in individuals with more advanced disease (see Prognosis).
LIMITATIONS OF ACM STUDIES
Conversely, the 3 subjects recording a less satisfactory evolution had persisted in their consumption of alcohol. It should be noted that a moderate drinker included in this latter group showed an improvement of his ejection fraction. Considering all the works conducted to date, it is clear that new studies on the natural history of ACM are needed, including patients treated with contemporary heart failure therapies. In light of the available data, new studies will help to clarify the current prognosis of ACM compared to DCM and to determine prognostic factors in ACM that might differ from known prognostic factors in DCM. The latest two papers to be published, unlike previous papers, reported worse outcomes for ACM patients compared to DCM patients.
- She admitted to an eight-year history of the ingestion of more than 600 mL of vodka per day.
- They found that there is about 14% loss of myocardial cells in the left ventricle of those rats.
- Her electrocardiogram showed sinus tachycardia, a nonspecific T-wave abnormality and right axis deviation.
- The diagnosis of ACM is usually one of exclusion in a patient with DCM with no identified cause and a long history of heavy alcohol abuse.
- Various studies with animals and humans indicate that ethanol can increase the development of reactive oxygen species (ROS), leading to increases in redox-signaling pathways and decreases in protective antioxidant levels.
- Ethanol-fed animals had reduced systolic contractility and responses to adrenergic stimuli (isoproterenol) compared to control animals (42).
Mechanisms Related to Alcohol’s Positive and Adverse Effects on CV Conditions
The patient came to the emergency room with a decreased level of consciousness, hallucinations and convulsions after 24 h to 48 h of abstinence from alcohol. Demakis et al70 in 1974 divided a cohort of 57 ACM patients according to the evolution of their symptoms during follow-up. The sub-group of patients in whom symptoms improved was made up of a larger proportion of non-drinkers (73%), compared to 25% in the group who did not improve, or 17% in the group whose condition worsened. However, a possible confusion factor was identified because the group with clinical improvement also exhibited a shorter evolution of the symptoms and the disease.
This review revisits our past and deals with our current thinking on the epidemiology, pathophysiology, clinical characteristics, and treatments available for alcoholic cardiomyopathy. Until the second part of the 20th century, there was no scientific evidence on the direct and dose-dependent effect of ethanol on the heart as cause of ACM 6,38. However, there is a clear personal susceptibility of this effect that creates a wide variability range and supposes significant inter-individual differences 50,66. In fact, ACM is considered to be the result of dosage and individual predisposition 32. Ask any patient presenting with new heart failure of unclear etiology about their alcohol history, with attention to daily, maximal, and lifetime intake and the duration of that intake.
Alcoholic cardiomyopathy: Cytotoxicity of alcohol on heart muscle
In contrast, beta-blockers, similar to aldosterone inhibitors, however beneficial they may be, have thus far not yielded sufficient data on their efficacy in relation to this disease. Basic research studies have described an abundance of mechanisms that could underscore the functional and structural alterations found in ACM. Because of this, their origin could be multifactorial and linked both to the alcohol molecule and to its main metabolite, acetaldehyde. In some people with dilated cardiomyopathy their heart starts pumping more efficiently again. The outlook with dilated cardiomyopathy varies and depends on the severity of the condition, and any other medical conditions a person has.
The biological reason for this gender difference is based on different ethanol absorption rates, distribution pattern, and metabolism in women compared to men 52. Therefore, efforts to prevent ACM development in women should be specifically addressed 97. During pregnancy, ethanol consumption should be clearly discouraged because of the possibility of fetal alcohol syndrome or the development of other congenital heart diseases 97. The majority of the echocardiographic studies performed on asymptomatic alcoholics found only mild changes in their hearts with no clear impairment of the systolic function. For example, a slight increase in the pre-ejection period/left ventricular ejection time ratio (PEP/LVET) was found by some authors, suggesting a sub-clinical impairment of systolic function21,33. Mathews and Kino found a small, but significant increase in left ventricular mass in individuals consuming at least 12 oz of whisky during 6 years and 60 g of ethanol per day, respectively22,40.
Mitochondrial Dysfunction and Changes in Mitochondrial Bioenergetics
- Acute or chronic right heart failure leads to elevation of liver enzymes most likely due to liver congestion, whereas cirrhosis due to cardiac disease is infrequent.
- Other findings may include cool extremities with decreased pulses and generalized cachexia, muscle atrophy, and weakness due to chronic heart failure and/or the direct effect of chronic alcohol consumption.
- This activity examines when this condition should be considered on differential diagnosis.
- About one in four people with idiopathic dilated cardiomyopathy have a familial (hereditary) form.
- Once doctors have found this, they will look for the cause of the weakened heart.
- Ethanol is one of the most addictive drugs for humans, with high physical and psychological addiction potential 7.
As noted above, chronic alcohol exposure leads to a decrease in mTOR activity, which corresponds to increased markers of autophagy (Lang and Korzick 2014). The autophagy pathway also is rapidly upregulated during ATP depletion, mitochondrial dysfunction, and oxidative stress. Ethanol-mediated increases in autophagy therefore may be an important mechanism underlying the adverse myocardial effects of ethanol. Pathophysiologic schema for the development of alcoholic cardiomyopathy (ACM). As noted in the text, the exact amount and duration of alcohol consumption that results in ACM in human beings varies.
A normal heart
Recently, Guzzo-Merello and colleagues (2015) reported that, among 282 patients with a dilated cardiomyopathy phenotype, 33 percent had ACM. However, some reports indicate that alcohol-dependent women develop ACM after consuming less alcohol over a shorter period than do age-matched alcohol-dependent men (Fernández-Solà et al. 1997; Urbano-Marquez et al. 1989). New therapeutic strategies for AC are being developed with the support of animal models. As the pathogenesis of AC is complex, specific treatments focus on different targets. These include damaging factors such as acetaldehyde or ROS, cardiac fibrosis, or apoptosis.
Since ethanol consumption of the global population is not currently under control 2, the incidence of alcoholic cardiomyopathy is expected to be maintained in the future, especially in specific population groups, such as adolescents and young people 3. Therefore, efforts for the prevention, early detection, and specific treatment in this relevant disease should be established 45. The direct dose-dependent effect between alcohol intake and development of ACM is clearly established 50,52, women being more sensitive than men to the toxic effects of ethanol on the heart 46. However, genetic polymorphisms, the use of other concomitant drugs (tobacco, cocaine), and the presence of other cardiac risk factors (hypertension, diabetes) may influence and worsen the natural course of ACM in each specific individual 27,72,98. The multiple sites of myocyte damage from alcohol 11,19,23 and the genetically mediated individual predisposition 32,153 create a large individual clinical variability and make it difficult to establish a simple effective treatment for ACM 27,30,52.
