These effects also may involve an irregular and often very fast heart rate (arrhythmia) during which the heart’s upper chambers (atria) contract chaotically out of coordination with its lower chambers (ventricles), known as atrial fibrillation, or (rarely) sudden cardiac death. Several reports indicate that alcohol first exerts a seemingly positive effect, followed by a more negative impact (i.e., it is biphasic) on the endothelial–nitric oxide–generating system. Endothelial dysfunction is an early indicator of blood vessel damage and atherosclerosis, as well as a strong prognostic factor for future CV events (Deanfield et al. 2007; Ras et al. 2013). Low-to-moderate levels of alcohol consumption may initially improve endothelial function, whereas high daily levels and binge drinking may impair it. Chronic ethanol misuse clearly depresses protein synthesis and degradation, involving both structural and non-structural heart proteins 104,128.
Mechanisms Related to Alcohol’s Positive and Adverse Effects on CV Conditions
- Among the many ethanol and heart studies, mitochondrial dysfunction or evidence of impaired bioenergetics has been a common finding.
- The prevalance of alcoholic cardiomyopathy in addiction units is estimated around %.
- In Munich, the annual consumption of beer reached 245 l per capita and year in the last quarter of the 19th century.
In the first of these studies, Fauchier et al11 studied 50 patients with ACM and 84 patients with DCM between 1986 and 1997. 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. Also, current common cardiac therapies such as ICD and CRT devices were not used because of the period when the study was conducted. After a follow-up period of 47 mo, a significantly higher survival rate was observed among patients with DCM compared to patients with ACM. In this study, the only independent predictor of cardiac death was alcohol abstinence.
Apoptosis and ACM
The exact mechanism by which an increased adherence to the traditional Mediterranean diet exerts its favorable effects is not known. Apoptosis occurs mainly as a consequence of lipid peroxidation and oxidative stress in various body organs. There is a significant association between cardiovascular disorders and apoptosis. There is also an established link between the development of ACM and apoptosis because of myocardial cell death, which contributes to heart pathology and dysfunction. Previous studies were conducted on rats that are fed alcohol for about eight months.
1. Oxidative and Energy Disturbances in ACM
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. Patients with alcoholic cardiomyopathy, cardiomyopathy alcohol therefore, usually present with symptoms of heart failure, i. Echocardiography may reveal a mild or severe depression of cardiac function and ejection fraction or even show hypertrophy in the beginning 109. Heart failure symptoms may be due to early diastolic or to later systolic dysfunction. At later stages, due to atrial fibrillation, thrombi are not uncommon in the dilated atria. Atrial fibrillation and supraventricular tachyarrhythmias are common findings in 15–20 % of patients 111, whereas ventricular tachycardias are rare 112.
Some studies have shown that the combination of carvedilol and trimetazidine with other traditional heart failure medications is effective 1-3,7-11,16-20. 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.
Impact of Drinking Patterns and Types of Alcoholic Beverages on Risk
- Out of end-stage cases, the majority of subjects affected by ACM who achieve complete ethanol abstinence functionally improve 33,82,135.
- This induces a variety of effects, since more than 14 different sites in the myocyte can be affected by ethanol 19,98.
- Pathologically, ethanol induces myocytolysis, apoptosis, and necrosis of myocytes, with repair mechanisms causing hypertrophy and interstitial fibrosis.
- Clinical overview, pathogenesis, treatment and prognosis of alcoholic cardiomyopathy.
Electrolyte abnormalities, including hypokalemia, hypomagnesemia, and hypophosphatemia, should be corrected promptly because of the risk of arrhythmia and sudden death. Chest radiographs usually show evidence of cardiac enlargement, pulmonary congestion, and pleural effusions. Richardson et al showed an elevation of creatine kinase, LDH, malic dehydrogenase, and alpha-hydroxybutyric dehydrogenase levels in endomyocardial biopsy specimens taken from 38 patients with DC. Myocardial depression secondary to alcohol is initially reversible however prolonged sustained alcohol use leads to irreversible dysfunction. To date, none of the ACM studies have proposed a treatment for ACM other than that recommended for DCM in current HF guidelines. Further research is required to determine the definitive role of genetics on ACM pathophysiology.
- However, there is evidence that there is enhanced autophagy in certain cardiac pathological conditions such as heart failure, cardiomyopathy, and cardiac hypertrophy, conditions in which there are increased levels of angiotensin II (69).
- In addition, there is a relevant role on each organ, particularly on defense and adaptive mechanisms, with a clear induction of anti-oxidant, metabolic, and anti-inflammatory protective responses as a result of ethanol aggression 18,25,26.
- Other ethanol-induced changes may be related to enzymes that modulate protein synthesis and/or breakdown (e.g., ubiquitine-ligases).
- When it comes to wine, one drink is defined as a 5-ounce (148 ml) serving, which typically contains about 12% ABV.
- We then proceeded with screening and selection based on the titles and abstracts of the initial search results.
Certain microscopic features may suggest damage secondary to alcohol causing cardiomyopathy. Commonly seen cellular structural alterations include changes in the mitochondrial reticulum, cluster formation of mitochondria and disappearance of inter-mitochondrial junctions. They commonly include fatigue, shortness of breath, and swelling of the legs and feet.