Alcoholic cardiomyopathy is a form of dilated cardiomyopathy caused by habitual, excessive use of alcohol. Alcohol in excessive quantities has a directly toxic effect on heart muscle cells.

Alcoholic cardiomyopathy results in poor heart function because the heart muscle is too weak to pump efficiently.  Alcoholic cardiomyopathy results in heart failure. Lack of blood flow affects all parts of the body, resulting in damage to multiple tissues and organ systems.

Incidence of alcoholic cardiomyopathy is 2 out of 1,000 people. The disorder is most commonly seen in males ages 35 to 55 years old, but it may become evident in older individuals. Alcoholic cardiomyopathy may be indistinguishable from idiopathic dilated cardiomyopathy.

• ankle, feet, and leg swelling
• swelling, overall
• pronounced neck veins
• loss of appetite
• shortness of breath, especially with activity
• breathing difficulty, lying down
• fatigue, weakness, faintness
• decreased alertness or concentration
• cough containing mucus, or pink, frothy material coughed up
• decreased urine output (oliguria)
• need to urinate at night (nocturia)
• sensation of feeling the heart beat (palpitations)
• pulse may feel irregular or rapid

Note: Symptoms are usually absent until the disease is in an advanced stage. Symptoms occur because of heart failure. Patients also often show muscular weakness because of a direct alcohol effect on muscles (alcoholic myopathy).

Examination and tests are directed at diagnosing and evaluating heart failure. Alcoholic cardiomyopathy is usually diagnosed when it is discovered as a cause of the heart failure. Alcoholic patients often have vitamin deficiencies, mainly thiamin -- the more severe form is beriberi.

Physical examination may reveal irregular or rapid heartbeat. There may be distended neck veins, enlarged liver, peripheral edema, and signs of pleural effusion (fluid around the lungs). Listening to the chest with a stethoscope (auscultation) may reveal lung crackles or abnormal heart sounds. Blood pressure may be low or may drop upon rising (orthostatic hypotension).

Heart failure may show on these tests:

• echocardiogram
• chest X-ray
• chest CT
• a cardiac catheterization and coronary angiography
• an ECG may show heart enlargement or arrhythmias.
• a myocardial biopsy may be helpful to distinguish alcoholic cardiomyopathy from other diseases that may cause cardiomyopathy.

This disease may also alter the results of a CPK test.

The goal of treatment is management of heart failure. Hospitalization may be required until acute symptoms subside. Cessation of alcohol consumption may slow or halt the disease progression.

Treatment for heart failure may include medications to improve heart function such as diuretics (e.g., furosemide) to remove excessive fluid from the body, or other medications. Low salt diet may be recommended in some cases. Fluid may be restricted. A heart transplant may be considered. Associated nutritional deficiencies (e.g., thiamin deficiency) and abnormalities in phosphorus, potassium or magnesium levels may require treatment.

• congestive heart failure
• cardiac arrhythmias, including lethal arrhythmias

Call your health care provider if symptoms of heart failure or cardiomyopathy develop.

Call your health care provider if alcoholic cardiomyopathy has been diagnosed and symptoms do not improve with treatment.

Go to the emergency room or call the local emergency number (such as 911) if severe chest pain, palpitations, or fainting occur in a person with alcoholic cardiomyopathy.