Alcoholic cardiomyopathy
The content of the article:
- Causes and risk factors
- Forms of the disease
- Disease stages
- Symptoms
- Diagnostics
- Treatment
- Possible complications and consequences
- Forecast
- Prevention
Alcoholic cardiomyopathy is a special case of dilated cardiomyopathy and develops as a result of prolonged toxic effects of ethyl alcohol on the myocardium. The partitions and walls of the heart chambers are stretched, as a result they become thinner, lose their tone, the contractility of the heart deteriorates.
The incidence of alcoholic cardiomyopathy is quite high. Most often, the disease is diagnosed in men who regularly drink alcohol (at least 100 ml of pure alcohol per day) for over 10 years. According to statistics, alcoholic cardiomyopathy is observed in every second patient with chronic alcoholism. The disease is especially widespread among representatives of the lower social strata, whose diet does not contain the required amount of protein, trace elements and vitamins.
Signs of alcoholic cardiomyopathy
Causes and risk factors
In the body, alcohol breaks down with the formation of acetaldehyde, a toxic substance that damages various organs and tissues.
Under the action of acetaldehyde, the following pathological processes occur in myocardial cells:
- violation of energy metabolism;
- decrease in the synthesis of ATP molecules (adenosine triphosphate);
- violation of electrolyte metabolism (magnesium, potassium and calcium).
In addition, the toxic effect of acetaldehyde on the adrenal glands causes their increased secretion of catecholamines, which, in turn, increases the myocardial oxygen demand, leads to oxygen starvation of its cells. In addition, catecholamines damage cell membranes, trigger lipid peroxidation, ultimately leading to the death of heart muscle cells.
Forms of the disease
There are several clinical forms of alcoholic cardiomyopathy:
- Classic shape. Patients complain of shortness of breath, pain in the heart and heart palpitations, aggravated at night. Arrhythmia is often observed. The severity of symptoms increases significantly 2-3 days after drinking alcohol in large doses.
- Pseudoischemic form. Patients are worried about pain in the region of the heart, of varying duration and intensity. They can occur both under the influence of nervous overstrain or physical exertion, and at rest and are often accompanied by disturbances in the heart rhythm.
- Arrhythmic form. Heart rhythm disturbances are characteristic - paroxysmal tachycardia, extrasystole, atrial fibrillation. Clinically, this is manifested by dizziness, heart palpitations, and fainting.
Pathogenesis of alcoholic cardiomyopathy
Disease stages
There are several clinical stages of alcoholic cardiomyopathy:
- It is characterized by recurrent pain in the region of the heart, sometimes accompanied by rhythm disturbances.
- It usually develops in patients with chronic alcoholism for more than 10 years. Signs of heart failure appear (cough, shortness of breath (worse when lying down), edema of the lower extremities, cyanosis of the lips, face, feet and hands). Serious heart rhythm disturbances, such as atrial fibrillation, occur. Stagnation of blood in the systemic circulation causes an increase in the liver.
- It manifests itself as severe cardiovascular insufficiency, in which an irreversible violation of the structure of internal organs occurs, as a result of which all functions of the body are seriously affected.
Symptoms
Symptoms of alcoholic cardiomyopathy are most pronounced in the first days of recovery from binge drinking. These include:
- heartache;
- dyspnea;
- heart rhythm disturbances;
- swelling.
Heart pain in alcoholic cardiomyopathy is usually not exercise-related. They occur in the early morning hours, are stabbing or aching in nature and last for a long time. Taking nitroglycerin does not relieve pain.
Heart pain and disturbance of its rhythm are bright symptoms of alcoholic cardiomyopathy
In a stuffy room or during physical exertion, patients have a feeling of acute lack of air, breathing becomes shallow and frequent. In the open air, shortness of breath is reduced. In the last stage, shortness of breath occurs not only under the influence of the slightest physical activity, but also at rest. To facilitate the act of breathing, the patient takes a forced semi-sitting position (orthopnea).
Violations of the heart rhythm are perceived as its fading, interruptions in work, dizziness is felt, and attacks of sudden weakness occur.
The progression of heart failure leads to the appearance of edema, enlargement of the liver and spleen. Over time, effusion pleurisy, pericarditis, ascites develop.
Diagnostics
The following instrumental methods are used to diagnose alcoholic cardiomyopathy:
- echocardiography;
- electrocardiography;
- stress tests (treadmill test, bicycle ergometry;
- daily ECG monitoring;
- chest x-ray;
- Magnetic resonance imaging.
Patients must necessarily be consulted by a narcologist to confirm the diagnosis of chronic alcoholism and prescribe specific treatment.
Treatment
To prevent the progression of alcoholic cardiomyopathy, a complete rejection of alcoholic beverages is necessary.
Avoiding alcohol is an important condition for successful treatment of alcoholic cardiomyopathy
Complex therapy:
- the appointment of drugs that improve energy metabolism and stimulate the synthesis of protein molecules in the myocardium;
- correction of arrhythmia with antiarrhythmic drugs and potassium salts;
- to suppress the process of lipid peroxidation and stop further damage by free radicals to the membranes of the heart muscle cells - the appointment of antioxidant agents, multivitamin preparations;
- in order to reduce hypoxia - the appointment of sessions of hyperbaric oxygenation, inhalation with humidified oxygen, prolonged exposure to the fresh air.
Possible complications and consequences
The most common complications of alcoholic cardiomyopathy are:
- progressive heart failure;
- congestive pneumonia;
- violations of conduction and heart rhythm;
- pulmonary embolism;
- sudden cardiac death.
Forecast
Only in the case of early diagnosis of the disease and on condition of refusal from alcoholic beverages is it possible to stabilize the patient's condition.
In general, the course of alcoholic cardiomyopathy is unfavorable. According to statistics, the 10-year survival rate does not exceed 25%. After the first symptoms of heart failure appear, the average life expectancy is 3-6 years. The death is usually caused by massive pulmonary thromboembolism, severe heart failure, or ventricular fibrillation.
Prevention
Prevention consists in actively identifying and treating people with chronic alcoholism.
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Elena Minkina Doctor anesthesiologist-resuscitator About the author
Education: graduated from the Tashkent State Medical Institute, specializing in general medicine in 1991. Repeatedly passed refresher courses.
Work experience: anesthesiologist-resuscitator of the city maternity complex, resuscitator of the hemodialysis department.
The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
