In that study, zinc supplementation suppressed some of the ethanol-induced changes in both the metallothionein knock-out mouse model and wild-type; however, ethanol-induced mitochondrial swelling and disorganization remained in both mouse groups. The beneficial heart wine as universal remedy in medieval ages by Hildegard von Bingen 11 found its later correlates in many observations at the beginning of modern medicine when coronary artery disease (CAD) and its risk factors and symptoms received more attention. Heberden 89 described angina so elegantly in 1786 and also added that ”considerable relief“ through ”wine and spirituous liquors“ could be expected. This observation led to the erroneous belief that alcohol is an immediate coronary vasodilator. Symptomatic relief of angina could be through the anesthetic effect of ethanol or through peripheral vasodilation, which could transiently reduce oxygen demand of the heart.
Treatment / Management
Symptoms of ACM are not specific and overlap with other forms of heart failure 30,41,58. They appear when ventricle dilatation, hypertrophy, and dysfunction are established. Later and progressively in the course of the disease, around 20% of women and 25% of men with excessive alcohol consumption develop exertion dyspnea and orthopnea, leading to episodes of left-ventricle heart failure 39,46,59. Depression of LV ejection fraction (EF) is the hallmark of this period that also occurs with a reduction in LV shortening fraction, increase in LV diameter, and mass indices that may be measured by echocardiography or cardiac MR spectroscopy 40,52. Congestive symptoms, such as the expression of right ventricular failure, with peripheral edema or anasarca, are characteristic of advanced cases of ACM 42,56. Others have demonstrated that long-term ethanol administration decreases myocardial protein expression and synthesis and accelerates protein degradation, suggesting that these alterations may represent a key pathophysiologic mechanism underlying the adverse effects of ethanol (62).
- Acetaldehyde is produced at a lower quantity in the heart as compared to the liver, and systemic acetaldehyde does not achieve toxic heart concentrations 77.
- During pregnancy, ethanol consumption should be clearly discouraged because of the possibility of fetal alcohol syndrome or the development of other congenital heart diseases 97.
- In contrast, European studies focusing on the prevalence of ACM included only subjects diagnosed with DCM and applied the consumption threshold of 80 g/d for ≥ 5 years, finding an ACM prevalence of 23%-47% among idiopathic DCM patients9-12 (Figure 1).
- Ethyl alcohol, also known as “ethanol” or usually just as “alcohol”, is the most consumed drug in human history 1.
- However, these limitations are counterbalanced by the considerable sample size and absence of selection bias.
Clinical manifestations and diagnosis of alcohol-induced cardiomyopathy
But also short- and long-term pressor effects mediated by the renin–aldosterone system and plasma vasopressin have been described 47, 48. For more than alcoholic cardiomyopathy symptoms 3000 years, alcoholic beverages have been consumed in multiple societies through the centuries and cultures. In the 16th century Paracelsus Theophrastus Bombastus from Hohenheim used this term for distilled liquor and called it alcohol 15. G., in medieval times, when people took advantage of the vasodilating properties of alcohol to treat angina pectoris or heart failure.
- In addition, it provides information not only on overall heart size and function, but on valvular structure and function, wall motion and thickness, and pericardial disease.
- In 1890, Strümpell listed alcoholism as a cause of cardiac dilatation and hypertrophy, as did Sir William Osler in 1892 in his textbook Principles and Practices of Medicine.
- Ethanol-fed animals had reduced systolic contractility and responses to adrenergic stimuli (isoproterenol) compared to control animals (42).
Oxidative Stress Contributes to ACM
- In a national inpatient sample study, some authors have reported ACM to be most common in white males aged between 45 and 59 2.
- This altogether supports a causal relationship between alcohol consumption and a hypertensive state.
- Although up to 81% of ACM patients received an ACEI, none received beta-blockers and the use of spironolactone was not specified, although it was probably quite low.
- In one six-patient study (12) focusing on alcoholic cardiomyopathy, the surprising histological findings on endomyocardial biopsy of two patients was found to be myocarditis with lymphocytic infiltration in association with myocyte degeneration or focal necrosis.
In the 1950s, evidence began to emerge that supported the idea of a direct toxic myocardial effect of alcohol, and research during the last 35 years has been particularly productive in characterizing the disease entity of alcoholic cardiomyopathy (AC). Alcoholic cardiomyopathy (ACM) is a type of heart disease that can result from chronic alcohol consumption. Experts do not know what quantity of alcohol a person needs to consume to develop ACM. They also have not identified the minimum length of time someone needs to drink alcohol before developing the condition.
Alcoholic cardiomyopathy: Cytotoxicity of alcohol on heart muscle
Therefore, complete abstinence from ethanol is the most useful measure to control the natural course of ACM 51,56,135. In fact, patients with ACM who abstain from alcohol have a better long-term prognosis than subjects with idiopathic dilated CMP 54. Out of end-stage cases, the majority of subjects affected by ACM who achieve complete ethanol abstinence functionally improve 33,82,135. The percentage of effective abstinence achievement on these patients submitted to specific programs ranges from 50% to 60% 8,9.
Let your healthcare professional know if you have a family history of the condition. Illustrations of a typical heart, as shown on the left, and a heart with hypertrophic cardiomyopathy. Note that the heart walls are much thicker in the heart with hypertrophic cardiomyopathy. Call 911 or your local emergency number if you faint, have trouble breathing or have chest pain that lasts for more than a few minutes. Alcoholic cardiomyopathy is a leading cause of non-ischemic dilated cardiomyopathy in United States.
So Hildegard von Bingen (1098–1179), one of the most prominent mysticians of her time, recommended her heart wine as a universal remedy. One liter of wine was cooked for 4 min with 10 fresh parsley stems, 1 spoon of vinegar, and 300 g honey and then filtered 11. Abnormal heart sounds, murmurs, ECG abnormalities, and enlarged heart on chest x-ray may lead to the diagnosis. Incidence of alcoholic cardiomyopathy ranges from 1-2% of all heavy alcohol users.
Caution for anticoagulation is warranted due to the problems of noncompliance, trauma, and overdosage especially in hepatic dysfunction. In alcoholic cardiomyopathy, similar to idiopathic dilated cardiomyopathy (DCM), beta 1‑adrenergic and muscarinic receptors are reduced in the myocardium itself and reduced responsiveness of the adenyl cyclase was shown, whereas catecholamine levels in the circulation may be elevated 104. As a net effect, negative inotropism may result and contribute to heart failure. In the mid-1960s, another unexpected heart failure epidemic among chronic, heavy beer drinkers occurred in two cities in the USA, in Quebec, Canada, and in Belgium.