Cardiomyopathy, Alcoholic

Incidence in USA: 15–20 million chronic heavy ethanol users.

As much as 50% of dilated cardiomyopathy may be ethanol-related.

Population at risk: Unclear; likely includes chronic ethanol users with at least 90 g of daily ETOH for at least 5 y (1 standard drink =12 g ETOH).

Gender: Male predominance.

Alcohol withdrawal

CHF

Dysrhythmias common: AFIB, PAC, PVC

Hypomagnesemia and hypokalemia common

Myocardial ischemia: Supply < demand (CAD rare).

Abnormal systolic and diastolic function.

Chronic alcohol use alters myocardial response to inotropes, especially epinephrine.

Alcohol withdrawal symptoms.

Insidious onset; Sx uncommon unless severely stressed until late in course.

Dilated cardiomyopathy: Ventricular hypertrophy early, chamber dilation later.

Low-output cardiac failure (as compared with high-output failure in cirrhosis and beriberi).

Malnutrition often coexists.

Direct myocardial damage by ethanol and its metabolites

Progressive chamber dilation and ventricular hypertrophy; microscopic fibrinoid deposition

Possible intracellular calcium dysregulation

Possible muscle excitation-contraction impairment