What Is Alcoholic Cardiomyopathy?
The onset of alcoholic cardiomyopathy is closely related to long-term large-scale alcohol intake. It mostly occurs in men aged 30 to 55. They usually have a history of excessive alcoholism for more than 10 years. The clinical manifestations are diversified, mainly due to cardiac insufficiency and rhythm. Abnormal. After abstaining from alcohol, the condition can be relieved or cured on its own. The incidence is high in Europe, America, Russia and other countries. Case reports have been distributed in China, and the incidence has been increasing in recent years.
Basic Information
- English name
- alocholic cardiomyopathy
- Visiting department
- Cardiology
- Multiple groups
- 30 to 55 year old men
- Common causes
- Closely related to long-term high alcohol intake
- Common symptoms
- Enlarged heart, palpitations, chest tightness, fatigue, weakness, arrhythmia, chest pain, etc.
Causes of alcoholic cardiomyopathy
- Alcoholic cardiomyopathy is the result of direct poisoning of the heart muscle with ethanol and its metabolites, acetaldehyde. The direct toxic effects of alcohol on cardiomyocytes are mainly manifested in the following aspects: damage the integrity of the cardiomyocyte membrane; affect the function of organelles; affect the permeability of cardiomyocyte ions; cause changes in intermediate metabolism during alcohol metabolism; Drinking alcohol can change the structure of regulatory proteins (myosin and tropomyosin) and affect myocardial diastolic function; Long-term heavy drinking can also cause nutritional imbalance in the human body, which can lead to vitamin deficiency, especially B vitamin deficiency, which can also increase Cardiac insufficiency. In addition, some additives in wine contain toxic substances such as cobalt and lead, which can cause poisoning or myocardial damage after long-term drinking. The interaction and influence due to the above reasons can eventually lead to the occurrence of alcoholic cardiomyopathy.
Clinical manifestations of alcoholic cardiomyopathy
- It usually occurs in men aged 30 to 55 years, usually has a history of excessive alcohol consumption for more than 10 years, and the clinical manifestations are diverse, mainly manifested as cardiac insufficiency and arrhythmia.
- Heart enlargement
- Often found by chance on chest X-ray or echocardiography. The heart is usually large in size, and the wall activity of those with heart failure is obviously weakened. When the heart cavity is significantly enlarged, it may be accompanied by relative valvular insufficiency murmur.
- 2. Congestive heart failure
- Long-term alcoholics often have mild hypofunction in the heart, including palpitations, chest tightness, fatigue, and weakness. Severe cases are characterized by congestive heart failure, usually total heart failure, but left heart failure is predominant, with symptoms such as dyspnea, sitting breathing, and paroxysmal dyspnea at night, as well as jugular vein distension, Liver congestion, lower limb edema, and pleural effusion.
- 3. Arrhythmia
- Arrhythmia can also be an early manifestation of this disease. Atrial fibrillation is the most common, followed by atrial flutter, frequent pre-ventricular contractions, pre-atrial contractions, and cardiac block. Because arrhythmia occurs more than on weekends or holidays after heavy drinking, it is called "holiday heart syndrome." This disease should be considered for those who have an unexplained arrhythmia after drinking. Sudden death in alcoholics may be related to ventricular fibrillation.
- 4. Chest pain
- Atypical chest pain may occur; there are also those with angina pectoris, which may be related to acetaldehyde promoting catecholamine release and stimulating -adrenal receptors, leading to coronary spasm.
- 5. Changes in blood pressure
- High blood pressure is common in patients with alcoholic cardiomyopathy, especially when the diastolic blood pressure increases and the systolic blood pressure is normal or low, which is called "decapital hypertension".
- 6. Other
- Long-term heavy drinking can simultaneously affect target organs such as the brain, nervous system, liver, and skeletal muscle, and cause corresponding symptoms.
Alcoholic cardiomyopathy
- 1. X-ray inspection
- Heart shadows generally increase, with a cardiothoracic ratio> 0.55. When combined with heart failure, pulmonary congestion, pulmonary edema, and even pleural effusion may occur. With treatment and abstinence, the increased heart shadow can be significantly reduced in the short term.
- 2. ECG
- The most common is left ventricular hypertrophy with ST-T abnormalities. ECG changes such as low voltage, atrial fibrillation, pre-ventricular contraction, pre-atrial contraction, atrioventricular block, and intraventricular block are also seen. Pathology is seen in some patients. Sex Q wave.
- 3. Echocardiography
- Mainly the left ventricular weight increased, the early ventricular septum and the left ventricular posterior wall slightly thickened, without accompanying systolic dysfunction, the left ventricular diastolic inner diameter was normal. When congestive heart failure occurs, the atrioventricular systolic and diastolic inner diameters increase, the wall motion decreases, and the left ventricular ejection fraction decreases. Echocardiography is of great value for early diagnosis and prognosis.
- 4. Cardiac catheterization and cardiovascular angiography
- In the subclinical state of alcoholic cardiomyopathy, there can be hemodynamic changes, often manifested as decreased ejection fraction, increased end-diastolic pressure, and increased end-diastolic volume and tension. Ventricular angiography showed enlarged left ventricle, weakened diffuse wall motion, and decreased ventricular ejection fraction.
- 5. Radionuclide inspection
- Examination with a 111 indium-labeled monoclonal anticardiac antibody found that patients with dilated cardiomyopathy and alcoholic cardiomyopathy had increased radionuclide intake when cardiac function deteriorated, but decreased when clinical symptoms improved, and their intake was closely related to alcohol consumption , And the prognosis can be judged based on the intake.
- 6. Myocardial endocardial biopsy
- The high incidence of edema on the inner wall of mitochondria and coronary arteries is helpful to the diagnosis.
Diagnosis of alcoholic cardiomyopathy
- 1. Have a lot of drinking history (125ml / day of pure ethanol, that is, 4 bottles of beer or 150g of white wine), and have symptoms and signs of heart disease for more than 10 years.
- 2. This disease should be considered if other heart diseases can be ruled out. Compulsory abstinence for 4-8 weeks, the condition improved rapidly after active treatment, and also supports the diagnosis of alcoholic cardiomyopathy.
Differential diagnosis of alcoholic cardiomyopathy
- Dilated cardiomyopathy
- Alcoholic cardiomyopathy is very similar to dilated cardiomyopathy. Some scholars have compared the histology and clinical characteristics of the two. The results show that some patients with dilated cardiomyopathy have evolved from myocarditis, so their cardiomyocytes have hypertrophy, fibrosis, and nucleus These changes are more obvious than alcoholic cardiomyopathy.
- 2. Vitamin B 1 deficiency heart disease
- The dilated heart cavity, tachycardia, increased venous pressure, and lower limb edema manifested by alcohol myocarditis are easily confused with vitamin B 1 deficiency heart disease. However, the former is mostly a state of low cardiac output due to reduced ventricular contractility, while the latter is a state of high cardiac output, which can be clinically identified.
Alcoholic cardiomyopathy treatment
- Treatment principle
- (1) Persuasion or mandatory abstinence.
- (2) Rest in bed.
- (3) Treatment of heart failure.
- (4) Dealing with arrhythmias.
- (5) Supplement vitamins and strengthen nutrition support treatment.
- 2. Drug treatment
- The key to treatment is early diagnosis, early abstinence, and symptomatic treatment in order to extend or reverse the condition. When concomitant with heart failure, you should stay in bed, eat a high-nutrition, high-protein, low-salt diet. Angiotensin-converting enzyme inhibitors, small doses of digitalis can be used to strengthen the heart, intermittent diuresis, and at the same time vasodilation. Abstinence is more important. Regardless of whether blood magnesium is reduced, magnesium should be supplemented for a long time. Due to the lack of B vitamins, it should be supplemented in large quantities. Ethanol can interfere with the transport of calcium ions in the membrane of myocardial cells. Calcium antagonists can be tried out. Those with obvious arrhythmia in the early stage can choose diltiazem or verapamil. Alcoholic cardiomyopathy is often accompanied by hyperlipidemia and methemoglobinemia, which is prone to thrombosis and sudden death. At the same time of treatment, actively persuade smoking cessation, rest in bed, and limit water intake.
Alcoholic cardiomyopathy prevention
- The occurrence of alcoholic cardiomyopathy is closely related to long-term intake of large amounts of alcohol. The key to its treatment is to quit drinking. Regardless of the severity of the disease, most patients are expected to obtain relief after quitting. Drug treatment itself is only an expedient measure. If you do not quit alcohol completely, the treatment of the disease will be a failure.