Alcoholic cardiomyopathy

Introduction to alcoholic cardiomyopathy Long-term heavy drinking can lead to myocardial lesions, which is similar to the manifestation of dilated cardiomyopathy, called alcoholic cardiomyopathy (ACM). In 1995, the World Health Organization and the International Federation of Cardiology (WHO/ISFC) working group experts In the report on the definition and classification of cardiomyopathy, alcoholic cardiomyopathy is classified as a cardiomyopathy caused by allergic and toxic reactions in specific cardiomyopathy, and the condition can be relieved or healed after alcohol withdrawal. The disease is mostly caused by adult males. The incidence rate in China has increased in recent years. basic knowledge The proportion of sickness: 0.003%-0.005% Susceptible population: more than 30 to 55 years old male Mode of infection: non-infectious Complications: arrhythmia congestive heart failure alcoholic cirrhosis malnutrition

Causes of alcoholic cardiomyopathy

Organelle dysfunction (35%):

Impairing the integrity of the myocardial cell membrane, through the biological properties of alcohol-soluble fat, invading the cell membrane to cause liquefaction and changing the cell membrane fat composition and molecular configuration, so that the membrane surface ion distribution and membrane potential are out of control, affecting cell-to-cell information transfer and ion exchange . Affects organelle function, including mitochondria, sarcoplasmic reticulum and other organelle dysfunction, resulting in reduced myocardial energy supply.

Reduced myocardial contractility (25%):

It affects the permeability of myocardial cell ions, so that potassium, phosphate or magnesium is lost from the myocardium, and calcium ion overload in myocardial cells can lead to decreased myocardial contractility, which is an important cause of cardiac dysfunction in alcoholic cardiomyopathy.

Long-term drinking (15%):

Long-term drinking can change the structure of regulatory proteins (pro-protein and promyosin) and affect myocardial relaxation and contraction. Long-term heavy drinking can still cause a balanced malnutrition in the human body, which may lead to vitamin deficiency, especially the lack of vitamin B. It can also aggravate heart dysfunction. In addition, some additives in alcohol contain cobalt, lead and other toxic substances, which can be consumed for a long time. Causes poisoning or myocardial damage, due to the interaction and influence of the above reasons, can eventually lead to the occurrence of alcoholic cardiomyopathy.

Alcoholic cardiomyopathy prevention

Life restraint pays attention to rest, work and rest, life is orderly, and maintaining an optimistic, positive and upward attitude towards life is of great help in preventing diseases. Do the regularity of tea and rice, live daily, not overworked, open-minded, and develop good habits.

Alcoholic cardiomyopathy complications Complications arrhythmia congestive heart failure alcoholic cirrhosis malnutrition

1. damage to the heart

(1) Arrhythmia: The damage of ethanol to the myocardium can be manifested as arrhythmia, and there are more cases of supraventricular arrhythmia. Atrial fibrillation is the most common, and there is even a risk of sudden death.

(2) Congestive heart failure: Ethanol causes diffuse myocardial damage, decreased cardiac output, and may have heart failure. Most of the symptoms of left heart failure are obvious, but at the same time, there is often a manifestation of right heart failure.

2. Damage to organs and organs other than the heart

(1) Alcoholic myopathy: Alcohol damages skeletal muscle.

(2) Alcoholic cirrhosis: 80% to 90% of ethanol is metabolized in the liver, and the metabolite acetaldehyde has great damage to liver cells, which can cause hepatocyte membrane lipid peroxidation and destroy the microtubule structure of liver cells. Injury to mitochondria, promote the proliferation of fibrotic tissue of the liver interstitial, and cause inflammatory cell infiltration in the liver. Long-term damage of liver cells and fibrous tissue hyperplasia often lead to cirrhosis.

(3) Malnutrition and vitamin deficiency: Many drinkers often do not eat or eat other foods, and long-term protein and some vitamins will not be adequately supplemented.

Symptoms of alcoholic cardiomyopathy Common symptoms Atypical chest pain, dyspnea, arrhythmia, alcoholic myocardial angina, ataxia, first hypertension, left heart failure, coronary artery spasm

The onset of the disease is concealed, mostly in men aged 30-55 years. It usually has more than 10 years of excessive alcohol abuse history, and the clinical manifestations are diversified, mainly manifested as cardiac insufficiency and arrhythmia.

Heart enlargement

It may be the earliest manifestation of alcoholic cardiomyopathy. The clinical symptoms of some cases are not obvious. It is often found in physical examination, chest X-ray or echocardiography. The heart is mostly large, and the wall activity of patients with heart failure is obviously weakened. When the heart chamber is significantly enlarged, it may be accompanied by relative valvular insufficiency murmur. In the early cases, the heart shadow can be rapidly reduced in a short period of time, and the heart shadow of the advanced patient is often difficult to return to normal.

2. Congestive heart failure

Long-term alcoholics often have a mild decline in heart function, even before the clinical symptoms of cardiac insufficiency, early patients may have no symptoms, or only manifested as palpitations, chest tightness, fatigue, etc., severe cases with congestion Sexual heart failure is a prominent manifestation, usually heart failure, but mainly left heart failure, dyspnea, sitting breathing and paroxysmal dyspnea at night, may also have jugular vein engorgement, hepatic congestion, lower limbs Edema and pleural effusion, etc., patients with milder conditions often get better after abstaining from alcohol, but the condition can be aggravated again when drinking alcohol.

3. Arrhythmia

Arrhythmia can also be an early manifestation of the disease, most commonly seen as atrial fibrillation, followed by atrial flutter, frequent ventricular premature contraction, atrial premature contraction and heart block; arrhythmia requires medication or electricity Cardioversion, but a few can restore sinus rhythm on their own; the same arrhythmia can occur repeatedly, because arrhythmia occurs more than after heavy drinking on weekends or holidays, it is called "holiday heart syndrome", can not explain after alcoholism The arrhythmia should consider the possibility of this disease, and the sudden death of alcoholics may be related to ventricular fibrillation.

4. Chest pain

Unless accompanied by coronary heart disease or aortic stenosis, angina usually does not occur, but atypical chest pain may occur; there are also angina pectoris, which may be related to acetaldehyde promoting catecholamine release, stimulating -adrenergic receptors Coronary artery spasm is related.

Examination of alcoholic cardiomyopathy

X-ray inspection

Heart shadow is generally increased, heart-thoracic ratio>0.55, combined with heart failure can have pulmonary congestion, pulmonary edema and even pleural effusion, with treatment and abstinence, increased heart shadow can be significantly reduced in the short term.

2. ECG

There may be a variety of ECG abnormalities, most commonly left ventricular hypertrophy with ST-T abnormalities, as well as low voltage, atrial fibrillation, ventricular premature contraction, atrial premature contraction, atrioventricular block and indoor conduction block. The electrocardiogram changed, and some patients showed pathological Q waves.

3. Echocardiography

Mainly for left ventricular weight increase, early ventricular septum and left ventricular posterior wall slightly thickened, without concomitant dysfunction, left ventricular diastolic diameter is normal, when congestive heart failure occurs, the atrioventricular contraction and diastolic diameter increase, The wall motion is weakened, the left ventricular ejection fraction is reduced, and echocardiography is of great value for early diagnosis and prognosis.

4. Cardiac catheterization and cardiovascular angiography

Alcoholic cardiomyopathy may have hemodynamic changes in the subclinical state, often manifested as decreased ejection fraction, increased ventricular end-diastolic pressure, increased end-diastolic volume and tension, ventricular angiography showing left ventricular enlargement, diffuse wall motion Decreased, the ventricular ejection fraction decreased.

5. Radionuclide examination

Examination with a monoclonal anti-cardiac antibody labeled with 111 indium revealed that patients with dilated cardiomyopathy and alcoholic cardiomyopathy had increased radionuclide uptake when heart function deteriorated, while intake decreased when clinical symptoms improved, although this was associated with alcoholic cardiomyopathy. The diagnosis is not specific, but its intake is closely related to the amount of alcohol consumed, and the prognosis can be judged according to the intake.

Diagnosis and identification of alcoholic cardiomyopathy

diagnosis

1. A large number of drinking history (125ml/d of pure ethanol, ie 4 bottles of beer or 150g of white wine), lasting for more than 10 years, the symptoms and signs of heart disease.

2. Can exclude other heart disease should consider this disease, mandatory alcohol withdrawal 4 to 8 weeks, rapid improvement after active treatment also supports the diagnosis of alcoholic cardiomyopathy.

Differential diagnosis:

It is differentiated from dilated cardiomyopathy, vitamin B1 deficiency heart disease, ischemic cardiomyopathy, and alcoholic liver disease.

1. Dilated cardiomyopathy: Alcoholic cardiomyopathy is similar to dilated cardiomyopathy. Some scholars compare the histology and clinical findings. The results show that some patients with dilated cardiomyopathy develop myocarditis, so their cardiomyocytes Hypertrophy, fibrosis and nuclear changes were more pronounced than alcoholic cardiomyopathy. In addition, the clinically measured cardiothoracic ratio, cardiac index, and systolic blood pressure/end-systolic volume were significantly improved after stopping alcohol consumption. And the former is not obvious.

2. Vitamin B1 deficiency heart disease: Alcoholic myocarditis manifests in dilated heart, tachycardia, increased venous pressure and lower extremity edema, which is easily confused with vitamin B1 deficiency heart disease (act disease). However, the former Mostly, the ventricular contractility is reduced, resulting in a low cardiac output state, while the latter is a high cardiac displacement state, which can be clinically identified.

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