Home / Treating an Alcoholic With Comorbid Medical Issues / Alcoholic Cardiomyopathy: Issues & Treatment

There has been a lot of hype surrounding alcohol and the potential heart-healthy benefits of moderate alcohol consumption. The American Heart Association (AHA) warns that while alcohol may serve to raise levels of "good" cholesterol (HDL, or high-density lipoprotein cholesterol) and decrease the rate of blood clotting (acting as a blood thinner), drinking alcohol can also lead to many negative cardiovascular complications. One such cardiovascular concern related to alcohol consumption is the development of cardiomyopathy, which are diseases of the heart muscle that can be caused by a variety of risk factors, AHA explains.

Cardiomyopathy leads to the heart muscle getting rigid, thick, and enlarged, which may weaken the heart and make it more difficult for it to effectively pump blood. Cardiomyopathy can then lead to arrhythmias (irregular heart rates), a weakened heart valve, or heart failure, which can be fatal. Alcoholic cardiomyopathy is a form of dilated cardiomyopathy that occurs due to excessive and long-term alcohol consumption.

AHA reports that dilated cardiomyopathy (DCM) is the most common form of cardiomyopathy and involves the heart's atria, ventricles, and chambers. Chronic alcohol abuse can cause alcoholic cardiomyopathy, or DCM, which can lead to congestive heart failure and other potential life-threatening complications.

Alcoholic Cardiomyopathy Explained

The Centers for Disease Control and Prevention (CDC) reports that as many as one out of every 500 American adults likely suffers from cardiomyopathy. The specific form of the disease, dilated cardiomyopathy may be inherited or can develop as a side effect of certain diseases or the introductions of toxins, including alcohol.

Ethanol, or alcohol, and its metabolites can have toxic effects on the heart muscle. As published in the journal Herz, around one-third of all cases of dilated cardiomyopathy may be caused by excessive alcohol use. The disease often starts in the left ventricle of the heart, dilating the muscle. When the muscle is dilated, it thins out and stretches, which then causes the chamber to enlarge. The left ventricle is the main pumping chamber of the heart so when it is impacted like this, it can be more difficult for it to contract as it should and effectively pump blood. The issues can then spread to the right ventricle of the heart and then to the atria. Alcohol weakens the heart muscle and can therefore contribute to the onset of DCM, which may then progress into heart failure.

In general, symptoms of alcoholic cardiomyopathy may not begin until the disease is already advanced. The New York Times reports the following as symptoms of advanced alcoholic cardiomyopathy:

  • Shortness of breath during sleep, causing frequent waking
  • Troubles breathing while laying in a prone position
  • Difficulties breathing, especially during exertion
  • Swelling of the legs, ankles, and feet, and swelling in general
  • Fatigue and weakness
  • Trouble concentrating or staying alert
  • Irregular pulse
  • Less urine output and the need to urinate during the night
  • Decreased appetite
  • Heart palpitations
  • Coughing up mucus or material that is frothy and pink in color
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Causes and Onset of Alcoholic Cardiomyopathy

The journal Current Atherosclerosis Reports publishes that the development of alcoholic cardiomyopathy is often the result of excessive drinking for at least 10 years or more. Genetic factors and other medical conditions can be involved in the onset of dilated cardiomyopathy as well. For example, the manner in which a person's body metabolizes alcohol, which is often genetic and biological, may influence how alcohol will impact the heart. Lifestyle choices, such as consuming a healthy and balanced diet and getting regular exercise, can also be connected to heart health and may play a role in why one person may develop alcoholic cardiomyopathy while another may not.

In general, excessive alcohol abuse is thought to be a major risk factor for the onset of alcoholic cardiomyopathy and other health and cardiac complications and side effects. Excessive drinking is defined by the CDC as:

A standard "drink" is classified by the Dietary Guidelines for Healthy Americans 2015-2020 as one shot of distilled spirits (1.5 ounces of 80 proof liquor, which contains 40% alcohol), one 12-ounce beer (which contains 5% alcohol), or one five-ounce glass of wine (which contains 7% alcohol).

Treatment for Alcoholic Cardiomyopathy

If a person continues to drink after the onset of alcoholic cardiomyopathy, the outcome is not good. The Canadian Journal of Cardiology warns that as many as 42 percent of people who continue to regularly consume alcohol after being diagnosed with the disease are likely to die within three years. Alcoholic cardiomyopathy may be reversible if a person stops drinking, and in just six months, individuals abstaining from alcohol may have noticeable improvement in the function of the left ventricle of their heart, and after 18 months, they may experience a complete recovery.

It is important to catch alcoholic cardiomyopathy as soon as possible, as a complete reversal of the disease may be possible if treatment and abstinence begin before fibrosis sets in. Treatment for alcoholic cardiomyopathy often includes programs designed to help a person withdraw from and stop drinking alcohol.

An alcohol addiction treatment that is prepared to manage co-occurring disorders is important, so medical complications can be managed. Alcoholic cardiomyopathy treatment may require a specialized diet low in salt as well as medications, such as ACE inhibitors, beta-blockers, or diuretics. In severe cases of congestive heart failure, a person may need an implantable defibrillator (ICD), a biventricular pacemaker, or even a heart transplant.

One of the main components of an alcoholic cardiomyopathy treatment program is to help a person abstain from drinking alcohol. Specialized residential alcohol addiction rehab programs can provide a structured and stable environment where trained professionals can help to manage both alcoholism and medical (or mental) illness complications and disorders.

Often, detox is the first stage of a rehab program. Medical detox is the safest method of withdrawal for someone who struggles with co-occurring disorders and is significantly dependent on alcohol. Physical alcohol dependence can create intense withdrawal symptoms when alcohol processes out of the body, and some of these symptoms can even be life-threatening, requiring constant medical supervision and often management through medications.

An alcohol addiction rehab program includes behavioral therapies and counseling sessions to help individuals learn healthy habits, coping mechanisms for stress and cravings, and tools for preventing relapse. Behavioral therapies can also help a person learn how to be more self-sufficient. Support groups are helpful as they are made up of peers who can offer encouragement and tips for remaining sober, and they can also provide a healthy social outlet.

An addiction treatment program can help to improve an individual's quality of life overall, and this includes helping with recovery from alcoholic cardiomyopathy.