Alcoholic Cardiomyopathy (ACM)

Chronic and heavy alcohol use can essentially poison the heart muscle cells, causing inflammation, enlargement of the heart, and scarring (fibrosis), all of which impair the heart’s ability to function properly.

Treatment for the disorder usually consists of complete cessation of alcohol use along with lifestyle changes that focus on heart health. In some cases, medication or a heart transplant may be the best treatment option.

How dangerous is alcoholic cardiomyopathy?

Alcoholic cardiomyopathy is a serious and potentially life-threatening condition.[1] 

If ACM develops, it’s a clear sign that treatment for alcohol use disorder (AUD) is needed. If drinking continues and the condition is not treated, the heart can simply stop working.

How does alcohol-induced cardiomyopathy happen? 

Alcohol-induced cardiomyopathy is defined by a weakened heart muscle that is inefficient at pumping blood, ultimately leading to heart failure.[1-3] 

Here’s how this condition develops:

Direct Toxic Effects of Alcohol

Ethanol, the main component of alcoholic beverages, has toxic effects on cardiac cells. Chronic alcohol consumption damages these cells in the heart muscle, interfering with its structure and function.

Alcohol Metabolism & Acetaldehyde Formation

When you consume alcohol, the body metabolizes it primarily in the liver. Ethanol is converted into acetaldehyde, a toxic substance, and free radicals during this process. Acetaldehyde is harmful to the heart cells.

Oxidative Stress & Inflammation

Acetaldehyde and free radicals generated during alcohol metabolism induce oxidative stress and inflammation within the myocardium. This oxidative stress damages the heart muscle cells and triggers inflammatory responses.

Cardiomyocyte Damage & Apoptosis

Oxidative stress and inflammation contribute to the death of heart muscle cells (cardiomyocytes) through a process called apoptosis. As more cardiomyocytes die, the heart’s pumping ability weakens.

Enlargement & Weakening of the Heart

The continuous loss of heart muscle cells along with the inflammatory responses and oxidative stress can potentially lead to enlargement of the heart chambers, particularly the left ventricle. This enlargement causes the heart to weaken and lose its ability to contract effectively.

Scarring & Fibrosis

Prolonged exposure to alcohol can cause fibrosis (scarring) in the heart muscle, further disrupting the heart’s normal structure and function. Fibrosis replaces healthy heart tissue with non-contractile scar tissue, impairing the heart’s ability to pump blood.

Blood Pressure & Fluid Regulation

Chronic alcohol consumption can disrupt blood pressure regulation and fluid balance in the body, adding strain to the heart. This can worsen heart function in individuals with alcoholic cardiomyopathy.

Nutritional Deficiencies

Chronic alcohol use often leads to poor nutrition and vitamin deficiencies. Inadequate nutrition can contribute to heart muscle damage and worsen the progression of alcoholic cardiomyopathy.

Genetic & Individual Factors

Genetic predisposition and individual susceptibility play a role in determining how alcohol affects an individual’s heart. Some individuals may be more prone to the toxic effects of alcohol on their heart muscle.

Who Does Alcohol-Induced Cardiomyopathy Impact?

Alcohol-induced cardiomyopathy primarily affects individuals who engage in chronic, excessive, and long-term alcohol consumption. It is directly correlated with the amount and duration of alcohol abuse. 

Here’s a breakdown of who is impacted by alcohol induced cardiomyopathy:[1,2,5]

Heavy & Chronic Alcohol Drinkers

People who consume large quantities of alcohol regularly over an extended period are at significant risk for ACM. Chronic heavy drinking is typically defined as consuming more than 15 drinks per week for men and more than 8 drinks per week for women. These individuals usually have AUD.

Long-Term Binge Drinkers

Those who engage in episodic or binge drinking (consuming a large amount of alcohol in a short period) over several years are at risk for ACM. The pattern of excessive drinking, regardless of the frequency, can lead to the development of this condition.

Individuals who have a history of heavy alcohol consumption, even if they have since reduced or stopped drinking, may still have the potential to develop alcoholic cardiomyopathy as a consequence of their past alcohol abuse.

Those With a Genetic Predisposition

Some individuals have a genetic predisposition that makes them more susceptible to the toxic effects of alcohol on the heart. Genetics can influence how the body metabolizes and reacts to alcohol, affecting the likelihood of developing alcoholic cardiomyopathy.

People With Nutritional Deficiencies

People with poor nutritional habits, often associated with chronic alcohol abuse, are more susceptible to ACM. Alcohol can interfere with the absorption of essential nutrients, and deficiencies in vitamins and minerals can exacerbate the damage to the heart muscle.

Vulnerable Populations

Certain populations are more vulnerable to ACM, such as middle-aged and older adults, as the risk of developing cardiac issues generally increases with age. 

Additionally, individuals with pre-existing cardiovascular conditions may experience more severe effects from alcohol-induced cardiomyopathy.

Is ACM a Common Condition?

When compared to other types of cardiovascular disorders, alcoholic cardiomyopathy is not common. In fact, it is considered relatively rare when compared to conditions like coronary artery disease, heart failure, or arrhythmias. 

However, ACM is a well-recognized consequence of long-term excessive alcohol consumption and one of the leading causes of nonischemic dilated cardiomyopathy.[1]

Impacts of ACM on the Mind & Body

Alcoholic cardiomyopathy primarily affects the heart and can have significant physical and mental impacts.

Physical Effects

The physical effects of ACM are often the first to manifest and include the following:[1]

Heart Failure

ACM weakens the heart’s ability to pump blood effectively, leading to heart failure. Because oxygen and nutrients cannot reach all areas of the body that demand them, symptoms like fatigue, shortness of breath, and fluid retention develop quickly.

Arrhythmias (Irregular Heartbeat)

ACM may interfere with your heart’s electrical signals and cause arrhythmias, potentially leading to palpitations, dizziness, fainting, or even sudden cardiac arrest in extreme cases.

Blood Clots & Stroke

The heart of a person with ACM may become weak enough for blood to pool and clot within its chambers, increasing risk for blood clots that travel to the brain, resulting in stroke.

Pulmonary Edema

Poor circulation from an underactive heart can result in fluid accumulation in the lungs, known as pulmonary edema. With this condition, breathing can be very difficult, progressing to life-threatening levels.  

Enlargement of Heart 

Because of the strain on the heart, its chambers can become enlarged, resulting in an overall stretching of the heart muscle. This weakens the heart, reducing its function.

Mental & Emotional Effects

The mental and emotional effects of living with ACM can be severe, including the following:[4,5]

Anxiety, Depression & Stress

Dealing with a serious heart condition like ACM can cause anxiety and stress, negatively affecting overall mental wellness.[4] Concerns about the future and managing the condition can be overwhelming, often leading to feelings of sadness, hopelessness, and depression.

Impact on Relationships

The overall impact of a chronic health condition like ACM can strain relationships with family and friends. Caregivers may experience emotional stress and burnout, as they attempt to manage the stressors of the condition for their loved one in addition to their own lives.

Cognitive Issues

In severe cases, alcoholic cardiomyopathy can negatively affect brain function because of reduced blood flow to the brain. Problems with concentration and memory may develop.

Signs & Symptoms of Alcoholic Cardiomyopathy 

Common signs and symptoms of alcoholic cardiomyopathy include the following:[1-3]

Breathing Issues

These are commonly described as shortness of breath. They generally worsen when lying down or during physical activity. These breathing problems can often cause sleep problems, including insomnia. Breathing issues can also lead to feelings of dizziness or faintness.

Fatigue

Overall weakness and tiredness are common, even with minimal physical exertion. The level of fatigue will increase with physical activity, but oftentimes, it doesn’t require much effort to feel significantly tired.

Swelling

This is most commonly seen in the legs, ankles and feet, but it can sometimes occur in the abdomen. It is due to fluid retention, also known as edema. Fluid retention can be significant, making a person look like they have gained weight suddenly despite a loss of appetite that generally accompanies ACM.

Chest Discomfort

This may be experienced as pressure, overall tightness, or a burning sensation in the chest. It is often accompanied by a rapid heartbeat.

Cough

People with ACM often experience a persistent cough that may feature whitish or pinkish phlegm. 

Cognitive Problems

With more advanced cases, ACM has been linked to confusion, concentration problems, and memory decline.

How to Diagnose ACM

A cardiologist will generally diagnose alcoholic cardiomyopathy. Here’s an outline of the diagnostic process for the condition:[1,6-8]

Medical History & Exam

You’ll be asked questions regarding your medical history and lifestyle, including how much alcohol you drink and for how long you’ve drank at those levels. The doctor will perform a physical exam to assess overall health.

Blood Tests

Blood tests can assess markers of heart damage, look for nutritional deficiencies, evaluate liver function, and rule out other potential sources of cardiovascular illness. 

Imaging Tests

Various types of imaging tests may be used to assess the structure, function, and overall health of the heart. Some possibilities include the following:

• Echocardiogram (echo)
• Chest x-ray
• Electrocardiogram (EKG or ECG)
• Cardiac MRI or CT scan

Holter Monitor or Event Recorder

These portable devices record your heart’s electrical activity for 24 to 48 hours or longer. They can record any irregular heart rhythms that might not be detected with traditional EKG testing.

Cardiac Catheterization

Under certain conditions, cardiac catheterization procedures may be performed to assess blood flow and pressures. They can also potentially detect blockages in coronary arteries.

Functional Tests

Exercise stress tests or functional assessments may be conducted to assess how your heart reacts during periods of physical exertion and stress.

Biopsy

On occasion and in exceptional cases, cardiac muscle biopsies may be undertaken in order to directly examine a small tissue sample from the heart for signs of cardiomyopathy.

Treatment Options for ACM

These are some of the key treatment options for ACM:[1,9-11]

Treatment for AUD

To effectively treat ACM, AUD must be treated and managed. If the individual continues drinking, treatment for ACM will be negated and further damage will occur.

Lifestyle Changes

With ACM, you’ll need to change habits to adopt an overall healthier lifestyle. Here are some basic steps that form the framework of a life that supports heart health:

• Eat a balanced diet that is rich in fruits, vegetables, whole grains, lean proteins, and healthy fats.
• Try to get regular physical exercise. While the general guideline is 150 minutes of moderately intense exercise per week, talk to your doctor about what is appropriate for you.
• Aim for a healthy weight. If you are overweight or obese, talk to your doctor about how to lose weight to reduce pressure on your heart.
• Stop smoking. Smoking puts significant strain on your heart, so ask your doctor for help in quitting.

Medications

Medication may be prescribed to manage symptoms of ACM. Depending on the medication, these approaches can  improve heart function, and control blood pressure. 

Common medications for these purposes include the following:[9,12]

• Angiotensin converting enzyme (ACE) inhibitors: These can be used to dilate blood vessels, reduce blood pressure, and enhance heart function.
• Beta blockers: These medications may lower heart rate, decrease blood pressure, and reduce strain on the heart.
• Diuretics: These are used to decrease fluid retention in the body.
• Aldosterone antagonists: These can help to maintain fluid balance and heart function.

Device Implantation

In advanced cases of heart failure, devices like implantable cardioverter defibrillators (ICDs) or cardiac resynchronization therapy devices may be implanted to regulate heart rhythms and improve cardiac performance.

Heart Transplant

In cases of ACM where heart damage is substantial, a heart transplant may be considered. This is considered a last-resort treatment option only after other treatments have proven unsuccessful.

What to Expect if You Have Alcoholic Cardiomyopathy

If you have alcohol cardiomyopathy, you must work closely with healthcare providers. Here’s an overview of what you might expect if you are living with ACM:[1,13-15]

Symptom Management

ACM will often include persistent symptoms. These will typically improve greatly with management of the condition, but you’ll need to continue to work with healthcare providers to keep them under control. You may need medication adjustments, and you’ll need to stay on top of lifestyle changes, such as getting regular exercise, to effectively manage symptoms.  

Ongoing Recovery

The most important part of your treatment is maintaining abstinence from alcohol. This is why treatment for alcoholic cardiomyopathy often begins with treatment for alcohol abuse. Since alcohol addiction is a chronic condition with no cure, you’ll need to continually manage it.

In rehab, you’ll learn relapse prevention techniques, so you’ll be able to deal with triggers that arise. You’ll also build a support system you can turn to when you are tempted to relapse. Though relapse might be part of your journey to sustained sobriety, you’ll know how to deal with it if it does occur, so it doesn’t derail your recovery.

Potential Complications

If left untreated, complications associated with ACM may occur, including heart failure, arrhythmias, blood clots, and stroke. The severity of these issues will depend on both how far along ACM has advanced as well as your response to treatment. The risk of all these complications is lowered significantly with effective management.

Long-Term Outlook for ACM

Individuals living with alcoholic cardiomyopathy face an unpredictable long-term outlook. However, with early diagnosis, supervised alcohol withdrawal, appropriate medical management, and lifestyle modifications, the condition can stabilize. This means improved heart function and a better overall quality of life. 

If you’ve been abusing alcohol heavily or for a long time, do not attempt to stop drinking suddenly on your own. This can be dangerous. You need professional assistance to withdraw from alcohol safely.[16] 

The journey to managing ACM begins with comprehensive treatment for alcohol use disorder. In a tailored treatment program, you can safely stop drinking and learn to live without alcohol abuse. You’ll build skills that enable you to cope with triggers, and you’ll address underlying issues that led you to abuse alcohol.

While relapse is often part of the process of recovering from AUD, you’ll learn how to cope with relapse, so it doesn’t derail your recovery. With the right help, you can achieve lasting recovery.

Medically Reviewed By Dr. Alison Tarlow

Dr. Alison Tarlow is a Licensed Clinical Psychologist in the States of Florida and Pennsylvania, and a Certified Addictions Professional (CAP). She has been a practicing psychologist for over 15 years. Sh... Read More