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Alcoholic Cardiomyopathy

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Description: Alcoholic cardiomyopathy is a disorder where chronic excessive alcohol consumption leads to the weakening and enlargement of the heart muscle, impairing its ability to pump blood effectively.
Type: Alcoholic cardiomyopathy is not a genetic disease; it is an acquired condition caused by chronic alcohol abuse. Therefore, it does not involve genetic transmission.
Signs And Symptoms: Signs and symptoms of alcoholic cardiomyopathy are indistinguishable from those seen in other forms of cardiomyopathy. These symptoms can include the following:
Ankle, feet, and leg swelling (edema)
This occurs because of a phenomenon known as third spacing. Third spacing occurs because the heart is unable to pump the blood throughout the body, and thus the fluid pools up in your veins. The fluid then eventually leaves your veins and enters the interstitial space, causing swelling. Doctors will sometimes test for pitting edema by pressing their fingers against the swelling to see if any "pitting" occurs.
Overall swelling
Loss of appetite
Shortness of breath (dyspnea), especially with activity
Breathing difficulty while lying down
This medical term for this symptoms is orthopnea, it occurs because fluid builds up in the posterior portion of both lungs, making it difficult to breathe.
Fatigue, weakness, faintness
Decreased alertness or concentration
Cough containing mucus, or pink, frothy material
Decreased urine output (oliguria)
Need to urinate at night (nocturia)
Heart palpitations (irregular heart beat)
Rapid pulse (tachycardia)The signs and symptoms of alcoholic cardiomyopathy (ACM) can vary depending on the severity of the condition. In the early stages, people with ACM may not experience any symptoms. However, as the condition progresses, they may experience symptoms such as fatigue, shortness of breath, palpitations, and swelling of the legs and ankles. They may also experience chest pain, dizziness, and fainting. In some cases, ACM can cause arrhythmias or irregular heartbeats, which can be life-threatening. In advanced cases, people with ACM may develop severe heart failure, which can cause symptoms such as severe shortness of breath, wheezing, and coughing. If left untreated, ACM can lead to life-threatening complications such as heart failure, arrhythmias, and sudden cardiac death. Therefore, it is important to seek medical attention if any of these symptoms are experienced, especially if there is a history of chronic alcohol consumption.
Prognosis: The prognosis is influenced by several factors, including the amount of alcohol and the time period over which it has been consumed, the presence or absence of dysrhythmias such as atrial fibrillation, and the width of the QRS complex. Some indications of poor prognosis include the following: patients with QRS > 120, patients who continue to consume alcohol for prolonged periods. Consumption of alcohol is directly related to the amount of alcohol consumed and length of consumption. Indicators of good prognosis include the following: successfully quitting the consumption of alcohol (associated with decreased hospital admissions), and patient compliance with beta blockers. Mortality is between 40–80% 10 years post-diagnosis.The prognosis of alcoholic cardiomyopathy (ACM) varies depending on the severity of the condition, the extent of heart muscle damage, and the response to treatment. Without treatment, ACM can progress to severe heart failure, arrhythmias, and sudden cardiac death. However, with proper treatment, including cessation of alcohol consumption and management of heart failure symptoms, the prognosis can improve significantly.Research has shown that the mortality rate for people with ACM is higher than that of the general population, with a five-year survival rate of around 50%. However, studies have also shown that people who stop drinking alcohol have a significantly better prognosis than those who continue to drink. In addition, people who receive early treatment for ACM, including medication and lifestyle modifications, have a better chance of improving their heart function and overall health.
The prognosis of ACM can also depend on the presence of other comorbidities such as diabetes, hypertension, and obesity. These conditions can exacerbate the effects of ACM on the heart and increase the risk of complications. Therefore, it is important to manage these comorbidities to improve the overall prognosis of ACM.
Onset: The onset of alcoholic cardiomyopathy generally occurs after prolonged, heavy alcohol consumption over many years. It typically affects individuals aged 35-55 years, though the specific timeline can vary based on the amount and duration of alcohol intake.
Prevalence: The prevalence of alcoholic cardiomyopathy varies widely due to differences in drinking patterns, genetic predispositions, and diagnostic criteria across populations. Generally, it is estimated that 1-2% of chronic heavy drinkers develop alcoholic cardiomyopathy. Chronic heavy drinking typically refers to consuming more than 80-90 grams of alcohol per day for at least 5-10 years.
Epidemiology: Alcoholic cardiomyopathy is a disease characterized by weakening of the heart muscle due to chronic alcohol consumption.

**Epidemiology:**
- Alcoholic cardiomyopathy is more common in individuals with a long history of heavy alcohol consumption.
- The condition tends to be more prevalent in men than in women.
- It typically affects individuals aged 35-55.
- Heavy alcohol intake over a period of years (usually at least 5-10 years) is the primary risk factor.
- Contributes to a significant proportion of non-ischemic dilated cardiomyopathy cases.

For the field "nan," there is no relevant information associated with epidemiology for alcoholic cardiomyopathy. "Nan" typically refers to "nanometers" in scientific contexts or is an abbreviation that may not apply here.
Intractability: Alcoholic cardiomyopathy can be managed but is often challenging to treat if alcohol consumption continues. Abstinence from alcohol is crucial and can stabilize or improve heart function. However, if the disease has progressed significantly, it may be less reversible, leading to persistent heart failure requiring long-term management.
Disease Severity: Alcoholic cardiomyopathy is a severe condition resulting from long-term heavy alcohol consumption, leading to weakened heart muscle, impaired heart function, and potentially heart failure. It is a form of dilated cardiomyopathy and can be life-threatening if not properly managed. The severity can range from mild symptoms like shortness of breath and fatigue to severe cases involving significant heart failure, arrhythmias, and even death. Reducing alcohol intake and seeking medical treatment are crucial for managing the condition.
Healthcare Professionals: Disease Ontology ID - DOID:12935
Pathophysiology: Alcohol-induced cardiac toxicity (AiCT) is characterized as either acute or chronic. It is believed that consumption of large amounts of alcohol leads to cardiac inflammation, which can be detected by finding large amounts of troponin in the serum. Chronic consumption of alcohol (defined as greater than 80 g per day for at least 5 years) can lead to multi-organ failure, including myocardial dysfunction. The exact pathophysiologic mechanism by which chronic consumption of alcohol causes DCM is not well understood, however it's believed that genetic mutation, and mitochondrial damage due to oxidative stress injury may play a role.
Carrier Status: Carrier status is not applicable to alcoholic cardiomyopathy. This condition results from long-term excessive alcohol consumption that leads to damage and weakening of the heart muscle. It is not an inherited or genetic disease.
Mechanism: Alcoholic cardiomyopathy (ACM) is a condition where chronic alcohol consumption leads to heart muscle damage, resulting in weakened cardiac function and heart failure.

**Mechanism:**
The primary mechanism involves the toxic effects of alcohol and its metabolites on cardiac muscle cells (cardiomyocytes). Chronic alcohol intake leads to progressive deterioration of myocardial structure and function, causing the heart to become dilated and weakened, impairing its ability to pump blood effectively.

**Molecular mechanisms:**
1. **Oxidative Stress:** Alcohol metabolism generates reactive oxygen species (ROS), which cause oxidative damage to cardiomyocytes, leading to cell injury and apoptosis.
2. **Mitochondrial Dysfunction:** Ethanol and its metabolites, particularly acetaldehyde, impair mitochondrial function, disrupting ATP production and promoting cell death.
3. **Sarcoplasmic Reticulum Dysfunction:** Alcohol impacts calcium handling by the sarcoplasmic reticulum, leading to impaired contraction and relaxation of heart muscles.
4. **Structural Protein Alteration:** Alcohol interferes with the synthesis of structural proteins such as actin and myosin, weakening the structural integrity and contractile function of the heart muscle.
5. **Inflammatory Pathways:** Chronic alcohol consumption activates pro-inflammatory cytokines and signaling pathways, contributing to myocardial fibrosis and remodeling.
6. **Apoptosis and Necrosis:** High levels of alcohol induce cardiomyocyte apoptosis and necrosis, leading to loss of functional myocardial tissue and contributing to heart failure.

Addressing alcohol consumption is crucial in managing and potentially reversing the progression of ACM.
Treatment: Treatment for alcoholic cardiomyopathy involves lifestyle changes, including complete abstinence from alcohol use, a low sodium diet, and fluid restriction, as well as medications. Medications may include ACE inhibitors, beta blockers, and diuretics which are commonly used in other forms of cardiomyopathy to reduce the strain on the heart. Persons with congestive heart failure may be considered for surgical insertion of an ICD or a pacemaker which can improve heart function. In cases where the heart failure is irreversible and worsening, heart transplant may be considered. Treatment will possibly prevent the heart from further deterioration, and the cardiomyopathy is largely reversible if complete abstinence from alcohol is maintained.Unfortunately, for patients that require heart transplants, cardiomyopathy due to alcoholism has the lowest post-heart transplant survival out of all causes of cardiomyopathy. Per one study that compared 224 alcoholic cardiomyopathy patients to over 60,000 non-alcoholic cardiomyopathy patients, survival post heart transplant was less at 1 year, 5 years, 10 years, and 12 years.Interestingly, in patients that are defined as "heavy drinkers" (defined as consuming >30g of alcohol/day) decreased alcohol consumption to moderate levels has been shown to be an effective treatment; in fact A retrospective cohort study analyzed data collected from over 3.8 million patients, and categorized patients as either abstinent drinkers, mild drinkers, moderate drinkers, and heavy drinkers. Despite having such a large sample size, the association between alcohol intake and cardiomyopathy remains unclear. The study found that patients that were either mild or moderate drinkers were the least likely to develop HF as compared to patients that were abstinent. The study also found that patients that increased their alcohol consumption from light to moderate and/or from moderate to heavy were at increased risk for heart failure. Although one might think that patients that were completely abstinent from alcohol would have would be least likely of being diagnosed with heart failure, it's actually patients categorized as either light or moderate drinkers had the lowest risk for developing HF.

== References ==
Compassionate Use Treatment: For alcoholic cardiomyopathy, compassionate use treatment, as well as off-label or experimental treatments, can be areas of consideration given the seriousness of the condition. Compassionate use refers to the use of unapproved therapies for patients who have no other treatment options and who are not eligible for clinical trials.

### Compassionate Use Treatment:
- **Heart Transplant**: In certain severe cases where other treatments are ineffective, a heart transplant may be considered under compassionate use.
- **Investigational Drugs**: These are not yet approved by regulatory bodies but might be accessible through expanded access programs.

### Off-label or Experimental Treatments:
- **Beta-blockers**: While beta-blockers like carvedilol or metoprolol are commonly used for heart failure, their use in alcoholic cardiomyopathy can be considered off-label.
- **Angiotensin II Receptor Blockers (ARBs)**: Medications like losartan may be used off-label to manage symptoms and improve heart function.
- **Stem Cell Therapy**: Various forms of stem cell therapy are under investigation and may be considered experimental.
- **Mechanical Support Devices**: Use of Left Ventricular Assist Devices (LVADs) can also be considered for patients with severe heart failure as a bridge to transplant or as a destination therapy.

These treatments require careful consideration and typically involve a thorough assessment of the patient's overall health, the severity of the cardiomyopathy, and other available treatment options.
Lifestyle Recommendations: For alcoholic cardiomyopathy, the primary lifestyle recommendation is:

1. **Alcohol Abstinence**: Complete cessation of alcohol consumption is critical to prevent further damage and potentially reverse some of the heart damage.

Additional lifestyle recommendations include:

2. **Healthy Diet**: Follow a heart-healthy diet that is low in saturated fats, cholesterol, and sodium.
3. **Regular Exercise**: Engage in moderate physical activity as recommended by a healthcare provider.
4. **Medication Adherence**: Take medications as prescribed to manage symptoms and prevent complications.
5. **Regular Monitoring**: Schedule regular check-ups with a healthcare provider to monitor heart function.
6. **Weight Management**: Maintain a healthy weight to reduce the strain on the heart.
7. **Smoking Cessation**: Avoid smoking to improve overall cardiovascular health.
Medication: Alcoholic cardiomyopathy is treated with medications aimed at managing heart failure symptoms and improving heart function. These may include:

1. **ACE Inhibitors or ARBs**: To lower blood pressure and reduce strain on the heart.
2. **Beta-Blockers**: To slow the heart rate and reduce blood pressure.
3. **Diuretics**: To help reduce fluid buildup in the body.
4. **Aldosterone Antagonists**: To manage fluid and sodium levels.

It is crucial for affected individuals to abstain from alcohol to prevent further damage to the heart. Regular follow-up with a healthcare provider is essential.
Repurposable Drugs: There are currently no widely recognized repurposable drugs for alcoholic cardiomyopathy. This condition primarily requires the cessation of alcohol consumption and supportive treatments such as heart failure medications, including ACE inhibitors, beta-blockers, and diuretics. Optimal management focuses on lifestyle changes and addressing the underlying alcohol abuse to prevent further progression.
Metabolites: Alcoholic cardiomyopathy (ACM) does not have a specific set of metabolites uniquely associated with it. However, excessive alcohol consumption, which leads to ACM, can cause alterations in various biochemical markers and metabolites, such as increased levels of acetaldehyde (a toxic metabolite of ethanol), elevated liver enzymes (AST, ALT, GGT), abnormal lipid profiles, and changes in amino acids and other metabolic pathways. Chronic alcohol intake can also result in deficiencies in essential nutrients like thiamine, which is crucial for cardiac function.
Nutraceuticals: Nutraceuticals, which are food products providing health benefits beyond basic nutrition, may play a supportive role in managing alcoholic cardiomyopathy, although they are not a substitute for conventional treatments. Nutraceuticals that may have potential benefits include:

1. **Omega-3 Fatty Acids**: Found in fish oil, they may help reduce inflammation and improve heart function.
2. **Coenzyme Q10 (CoQ10)**: An antioxidant that may support heart muscle function and energy production.
3. **L-Carnitine**: An amino acid that plays a role in energy production and may help improve heart function.
4. **Vitamin B Complex**: Particularly Thiamine (Vitamin B1), which is often deficient in individuals with chronic alcohol use and is essential for heart and nerve function.

While these nutraceuticals might offer benefits, the primary approach to treating alcoholic cardiomyopathy is to abstain from alcohol, follow a heart-healthy diet, and work with healthcare professionals to manage heart health.
Peptides: There is no direct correlation between peptides and the diagnosis or treatment of alcoholic cardiomyopathy. Alcoholic cardiomyopathy refers to damage to the heart muscle caused by long-term alcohol abuse, leading to heart failure. The primary treatment approach includes abstaining from alcohol, medications to manage heart failure symptoms, and lifestyle modifications. While research into peptides continues in various fields, they are not a standard part of managing alcoholic cardiomyopathy at present.