Introduction

What is alcoholic cardiomyopathy?

Alcoholic cardiomyopathy (ACM) is a condition in which chronic alcohol use weakens your heart, causing it to stretch and become larger. As a result, the heart muscles become weaker, meaning it is less able to pump blood around the body efficiently. This leads to the long-term consequence of a reduced oxygen supply to the body, causing headaches, higher heart rate, and difficulty in breathing. 

How does alcohol affect your heart?

Alcohol has many detrimental effects on cardiovascular health. It can increase the risk of conditions like coronary heart disease (CHD), hypertension and cardiomyopathy.¹ In healthy adults, low levels of alcohol being consumed each day has no short or long term effects on blood pressure; however, heavy drinking (more than 5 units in one sitting) each day causes a significant increase in blood pressure. The increase is due to a buildup of plaque in the arteries (atherosclerosis), making it harder for blood to flow through the vessels. In some cases, long term alcohol abuse can cause a heart attack or heart failure due to CHD caused by excessive drinking. If severe enough, it can be fatal. 

Alcoholic cardiomyopathy

ACM is a heart disease caused by long-term alcohol use. There is reduced cardiac function and widening of the left ventricle² (part of the heart responsible for pumping oxygenated blood out of the heart to the rest of the body). It is one of the maincauses of nonischemic dilated cardiomyopathy. This is a term used to describe conditions which cause decreased cardiac function (excluding heart attacks), and anything that is the result of blocked arteries. Dilated cardiomyopathy may be the result of genetic mutations, infections, or autoimmune diseases, which weakens the heart muscle.

Signs and symptoms

Those suffering from alcoholic cardiomyopathy may have the following symptoms:

• Fatigue
• Weakness
• Shortness of breath 
• Swelling of the ankles/legs/feet
• Episodes of dizziness and fainting
• Fast and irregular heart beat/pulse

Symptoms may not be apparent straight away. It is more likely to occur when the disease has progressed to a worsened state.

Diagnosis

ACM is diagnosed through many different tests, as explained below:³

• Firstly, a medical history is taken to find out about alcohol consumption and history of heart disease within the family. Symptoms above are also assessed
• A physical examination is also done to identify any abnormal heart sounds, any swelling, or alcohol related issues such as an enlarged liver
• Blood tests are used to look at how the liver is functioning (indicative of those who suffer from alcoholism), and cardiac biomarkers like BNP and troponin. If these are increased, it can suggest heart disease. A full blood count is done to look at anaemia caused by chronic alcoholism
• An echocardiogram is used to create an image of the size of the heart and structure e.g. it can show whether there is a larger ventricle which indicates cardiomyopathy
• Chest X-rays can be used to look at the size of the heart and how the lungs are functioning
• Cardiac MRI are used for a detailed picture of the heart function and structure
• An electrocardiogram is used to identify any abnormal heart rhythms 

A diagnosis is made by combining findings from multiple tests, along with the medical history. There is no single test that can be used to diagnose alcoholic cardiomyopathy; rather, a comprehensive investigation is needed. 

Effects of alcohol abuse on heart size

Normal heart function and anatomy 

The heart has four chambers divided into a left and right pump. The function of the heart is to pump blood around the body.⁴ The right atrium receives deoxygenated blood (blood that has very little oxygen) which then goes to the right ventricle. The right ventricle is the chamber responsible for pumping in the right side of the heart. This ventricle pumps blood into the lungs for it to gain oxygen, where it then goes to the left atrium. Blood high in oxygen goes into the left ventricle which then goes to the rest of the body. This whole process is repeated in the next heartbeat.

Short-term effects of alcohol on the heart

Alcohol usually has negative impacts on health and function. When alcohol is consumed, it is rapidly spread through the cardiovascular system. The first effects you may feel are increased blood pressure and heart rate. When you start drinking larger amounts regularly, there will be more short-term effects, including:

• Slower breathing
• Heightened blood pressure
• Abnormal heart rhythms 
• A higher chance of suffering from a heart attack or stroke

These problems can put you at a greater risk of developing a serious heart condition if not managed. 

Long-term effects of alcohol on the heart

For individuals that regularly drink large amounts of alcohol, there is a greater risk of several serious health conditions. Some of these are:

• Heart disease
• Weakened heart muscle
• Heart enlargement
• Coronary heart disease
• Heart arrhythmias 
• A build of plaque blocking arteries (atherosclerosis)
• Obesity 

Treatment and management options

Many health issues arise from long term alcohol abuse and alcoholic cardiomyopathy. Treatments should target the alcohol use, including counseling, as well as medical intervention such as medication. If detected early, the heart can recover much of its function if alcohol is stopped and the appropriate treatment is given. The treatment varies from person to person and depends on the severity of the condition.⁵ Below are some of the options available:

Stopping alcohol and rehabilitation

One of the most important steps of treating alcoholic cardiomyopathy is stopping the use of alcohol. At this stage, continuing to drink alcohol will only make the heart weaker. There is support in place to safely withdraw and stop. 

Some help available includes:

• A medical detox where alcohol withdrawal is done in a clinical setting under supervision to help manage symptoms 
• Rehabilitation and therapy will be key in getting the support required
• Support groups
• Relapse prevention studies can also give tools needed to help avoid relapsing
• Medication can be given to help manage dependence on alcohol for example, naltrexone (helps to reduce cravings for alcohol) and disulfiram (results in an unpleasant reaction if alcohol is drunk)

Treating the heart

As the heart becomes larger and weaker, medical intervention is needed to help prevent the heart function getting worse.⁶ To manage the health of the heart, the following can be done:

• ACE inhibitors are medication that are given to manage heart failure and reduce blood pressure
• Beta-blockers can reduce the faster heart rate
• An implantable cardioverter-defibrillator can be given in severe cases
• Cardiac resynchronisation therapy can help with heart contractions

Lifestyle changes

Changes to how you live and eat can have huge benefits in managing alcoholic cardiomyopathy. A healthy diet incorporating fruits, vegetables, and whole grains can help improve the health of the heart. Suitable, regular exercises should be done to stay active and healthy. Additionally, stress should be kept at a minimum, so activities like yoga and meditation could be added into your routine as a way of destressing. 

Summary 

Alcoholic cardiomyopathy is caused by chronic alcohol abuse, which damages and enlarges the heart. This means the heart is less able to pump blood around the body, causing a decrease in oxygen flowing through. As a result, common symptoms of tiredness, abnormal heart rate, and shortness of breath are experienced.

To diagnose ACM, many tests are required. A physical examination needs to be done, blood tests need to be drawn, and several different types of imaging is also needed. This, combined with the medical history, helps to conclude the diagnosis. As well as this, these tests are completed to rule out other possibilities, making it easier to determine whether or not the patient has the condition. 

The treatment combination of medical help and lifestyle changes highlights the impact alcohol can have on our body and why it is so important to control how much you drink. Recovery for ACM is not easy, but there is support in place for those that are affected. The more we learn about the damaging effects alcohol abuse can have on the heart, the greater the drive there is to stop drinking quantities that will cause harm. This can act as a powerful prevention technique. There are many ways to overcome alcohol abuse and cardiomyopathy with the right support in place. 

For anyone struggling with alcoholism, the links below may help:

• https://www.alcoholics-anonymous.org.uk/newcomers/
• https://clearminds.com/products/binge-free-weight-alcohol-control-package?gad_source=1&gbraid=0AAAAABe8cZg1vSZBVxqG_gDrym0S6Qnur&gclid=EAIaIQobChMIi4jHjauHiQMVIYCDBx3zmgRtEAAYAyAAEgJ_oPD_BwE
• https://www.nhs.uk/live-well/alcohol-advice/alcohol-support/
• https://www.mind.org.uk/information-support/types-of-mental-health-problems/recreational-drugs-alcohol-and-addiction/drug-and-alcohol-addiction-useful-contacts/
• https://www.drinkaware.co.uk/advice-and-support/alcohol-support-services