Alcoholic Cardiomyopathy (Alcohol-Induced Heart Disease)

Overview: Heart Disease & Who It Affects 

Heart disease, also called cardiovascular disease, is a group of heart conditions that lead to structural issues, blood clots, and diseased vessels. Heart disease can develop in both young and older adults, but the risk increases with age. For example, about 1 in every 100 men over 45 begin to show signs of heart disease. For women, the risk of cardiovascular disease increases after 55 years of age. 

Heart disease is one of the leading causes of death in the U.S. (every one in four deaths). These conditions can usually be treated with medications or surgery if they are caught early enough. 

There are many different types of heart disease. The most common type is coronary artery disease, which damages the heart’s major blood vessels. The leading causes of heart disease include:

• Uncontrolled high blood pressure
• Excessive alcohol intake, which leads to alcoholic cardiomyopathy
• Poor blood cholesterol levels 
• Diabetes mellitus
• Eating foods that are high in trans fat, saturated fat, and cholesterol (long-term)
• Obesity
• Long-term and regular tobacco use (including cigarettes, cigars, and chewing tobacco)
• Family history of heart attacks
• Metabolic syndrome

What Is Alcoholic Cardiomyopathy?

Studies have shown that moderate alcohol consumption may lower your risk of heart disease. However, heavy drinking can raise blood pressure levels. It also increases triglyceride levels in the body, which is a fatty substance in the blood that is linked to the development of heart disease.  

A standard drink is 12 ounces of beer, 1.5 ounces of an 80 proof liquor, or 5 ounces of wine. Safe, moderate drinking is defined as: 

• One drink or less per day for women.
• Two drinks or less per day for men.
• No more than one drink per day for men over 65. 

If your alcohol intake exceeds this amount on a regular basis, the risk for alcohol cardiomyopathy increases. Alcoholic cardiomyopathy is a type of dilated cardiomyopathy. In other words, it is a specific type of heart disease that damages the heart muscle. It is connected to long-term, chronic alcohol abuse and causes extreme alcohol toxicity to the heart muscle.

Men between 35 and 50 years of age are most at risk of developing alcoholic cardiomyopathy. Women can also develop this form of heart disease, but it is less common.

Causes of Alcohol Cardiomyopathy

The main cause of alcohol cardiomyopathy is linked to chronic alcohol addiction. Alcohol abuse and dependency are both considered alcohol use disorder (AUD). However, everyone who drinks doesn't develop an AUD. Abuse or misuse of alcohol doesn't mean that those people are addicted or dependent on alcohol. A person can misuse alcohol without drinking on a consistent basis, such as binge drinking.

Alcohol dependence often forms due to chronic alcohol abuse. Dependence is characterized by uncontrollable drinking patterns and a strong urge to drink alcohol. This stage of alcohol misuse is when tolerance develops and serious withdrawal symptoms occur after stopping use. Alcohol dependence is also called alcohol addiction or alcohol use disorder (AUD).

Alcohol has a toxic effect on many of your organs, such as the heart. As a result, long-term alcohol abuse can damage your heart muscle over time. This makes it difficult for your heart to pump blood properly, causing it to enlarge and thin out. Once the heart muscle and surrounding blood vessels stop functioning correctly, alcoholic cardiomyopathy may have formed.

Symptoms of Alcoholic Cardiomyopathy

The symptoms of alcoholic cardiomyopathy appear differently for everyone — some may develop severe symptoms, while others develop minor symptoms. In general, though, the primary indicators of advanced alcoholic cardiomyopathy include:

• Difficulty breathing, especially while exercising
• Shortness of breath, typically during sleep, causing you to wake up frequently
• Heart palpitations
• Poor appetite 
• Irregular or fast heart rate
• A persistent cough that produces a pink mucus
• Problems with urination
• Fatigue
• Muscle weakness
• Dizziness
• Swollen feet, ankles, or legs
• Memory issues
• Trouble focusing on daily tasks

Risk Factors of Alcoholic Cardiomyopathy

If alcoholic cardiomyopathy is left untreated or becomes advanced, heart failure can occur. Heart failure, also called congestive heart failure, happens when the heart muscle becomes too weak and stops pumping blood normally. Symptoms of congestive heart failure include shortness of breath, swollen legs, chronic fatigue, rapid heart rate, and chest pain, among others. The condition cannot be cured, but treatment can help relieve symptoms.

Other risk factors associated with advanced alcoholic cardiomyopathy include:

• Heart attacks
• Leaking heart valves
• Blood clots
• Extremely high blood pressure
• An enlarged heart
• Atrial fibrillation (irregular heartbeat), which can lead to stroke, blood clots, heart failure, and other serious health complications
• Arrhythmia, a less severe form of irregular heart rhythm
• Death

Outlook, Diagnosis & Treatment Options

The outlook for someone with alcoholic cardiomyopathy depends on how long they abused alcohol, their age, and the stage of the condition. If the heart is severely damaged, the chances of a full recovery are low. If the disease is caught early, stopping alcohol use completely and taking certain medications can help restore the heart’s function. 

To diagnose alcoholic cardiomyopathy, there are a few types of imaging tests that may take place. These include chest x-rays, CT scans, and an echocardiogram (uses sound waves to take photos of your heart). An electrocardiogram (EKG) may also be used to check the electrical signals of your heartbeat.

After the diagnosis, treatment is next. Alcoholic cardiomyopathy treatment may include medications, surgery, or a combination. Depending on the severity of the condition, your doctor may suggest:

• Eating a healthier diet (less saturated and trans fat) to improve cardiac function.
• Stopping alcohol use altogether.
• Taking certain medications, such as diuretics, ACE inhibitors, and beta-blockers to reduce heart strain. 
• Heart surgery or a heart transplant, depending on the stage of the condition and whether the patient can undergo surgery.

Up to 42 percent of people who keep drinking alcohol after being diagnosed with alcoholic cardiomyopathy will likely die within three years. However, the disease may be reversible if the individual stops drinking alcohol altogether. 

Within just six months of stopping alcohol use, the patient may notice an improvement in their heart function and overall health. Within 18 months of abstinence, a complete recovery is likely to occur.