Alcoholic cardiomyopathy is a disorder in which drinking too much alcohol over a long period of time weakens the heart muscle so that it cannot pump blood efficiently.

Drinking alcohol in large quantities has a toxic effect on the heart. Alcoholic cardiomyopathy is a form of a condition in which the heart becomes enlarged and the heart muscle thins (dilated cardiomyopathy) due to alcohol abuse.

Alcoholic cardiomyopathy causes the weakened heart muscle to pump inefficiently, leading to heart failure. In severe cases, the lack of blood flow affects all parts of the body, damaging many tissues and organs.

The disorder is most commonly seen in men ages 35-55. However, it may develop in anyone who drinks too much alcohol over a long period of time.

Alcoholic cardiomyopathy may be confused with dilated cardiomyopathy of unknown cause (idiopathic dilated cardiomyopathy) if the person's drinking history is not known.

There are usually no symptoms until the disease is in an advanced stage. At that point, the symptoms occur due to heart failure and may include:

• Ankle, feet, and leg swelling
• Awakening during the night with shortness of breath (paroxysmal nocturnal dyspnea)
• Breathing difficulty while lying down (orthopnea)
• Cough containing mucus, or pink, frothy material
• Decreased alertness or concentration
• Decreased urine output (oliguria)
• Fatigue, weakness, faintness
• Irregular or rapid pulse
• Loss of appetite
• Need to urinate at night (nocturia)
• Overall swelling
• Sensation of feeling the heart beat (palpitations)
• Shortness of breath, especially with activity (dyspnea)

A health care provider will conduct a physical examination, which may show:

• Abnormal heart sounds
• Abnormal lung sounds
• Ankle swelling
• Enlarged liver
• Irregular or rapid heartbeat
• Low blood pressure
• Murmurs
• Swollen neck veins
• Weight gain

Alcoholic cardiomyopathy is usually diagnosed when chronic heavy drinking is discovered as a cause of heart failure.

The following tests may reveal signs of heart failure:

• Echocardiogram may show enlarged heart chambers, leaking valves, or reduced pumping efficiency
• ECG may show signs of enlarged heart chambers or rhythm abnormalities (arrhythmias)
• Cardiac catheterization and coronary angiography may rule out coronary artery blockages as the cause
• Chest x-ray or chest CT may show heart enlargement, fluid buildup in the lungs and valves, and reduced pumping function
• Complete routine laboratory study measures the hormone B-type natriuretic peptide (BNP)

You may be placed on a low-salt diet. The amount of liquids you drink may be restricted. It is very important that you stop drinking alcohol completely.

Heart failure may be treated with:

• ACE inhibitors
• Beta blockers
• Diuretics (furosemide and spironolactone)

In people with congestive heart failure and severely weakened heart pumping, an implantable defibrillator (ICD) may help them live longer. Sometimes a biventricular pacemaker can improve symptoms and quality of life. The health care provider may recommend a single device that combines a biventricular pacemaker and an ICD.

A heart transplant may be considered when the cardiomyopathy is not reversible.

Eventually, nutritional problems involving thiamine, phosphorus, potassium, or magnesium levels may require treatment.

For more information on support groups where members share common experiences and problems, see alcoholism support groups and heart disease support groups.

Not drinking any alcohol may stop the disease and improve the heart's functioning. However, people with severe heart damage may never return to normal.

Once the heart damage and heart failure is irreversible, the outlook is poor.

• Congestive heart failure
• Heart arrhythmias, including lethal arrhythmias

Call your provider if you have:

• Symptoms of heart failure or cardiomyopathy
• Been diagnosed with alcoholic cardiomyopathy and your symptoms do not improve with treatment

Go to the emergency room or call 911 if you have alcoholic cardiomyopathy and experience:

• Fainting
• Palpitations
• Severe chest pain

Alcoholic cardiomyopathy is a consequence of years of excessive alcohol use. Do not use alcohol in excess. If you drink heavily and find that you cannot cut down or stop drinking, seek help.

Control other risk factors for heart disease by maintaining a healthy weight and exercising regularly. Eat a generally well-balanced, nutritious diet, and avoid smoking.

Hare JM. The Dilated, Restrictive, and Infiltrative Cardiomyopathies. In: Libby P, Bonow RO, Mann DL, Zipes DP. Libby: Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 64.