High blood pressure

Introduction Alcoholic cardiomyopathy patients with high blood pressure are common, especially the increase in diastolic blood pressure and normal or low systolic blood pressure is called "to the first high blood pressure", which is different from primary dilated cardiomyopathy. Alcoholic cardiomyopathy refers to the relationship between the onset and long-term large amount of alcohol intake. It has hemodynamic changes, symptoms, signs and imaging findings of typical dilated cardiomyopathy, and the condition can be relieved or healed after alcohol withdrawal. a type of myocardial disease.

Cause

The pathogenesis of this disease is closely related to long-term large amount of alcohol intake. It has hemodynamic changes, symptoms, signs and imaging findings of typical dilated cardiomyopathy. The exact pathological mechanism is still unclear. At present, most scholars believe that ethanol can cause myocardial damage.

Alcohol damage to the heart

Alcohol and its metabolites - acetaldehyde and acetate, can directly poison the heart muscle, lack of certain vitamins (vitamin B minerals (selenium, etc.) or electrolytes (magnesium, phosphorus, potassium, etc.) will aggravate the effect of alcohol on myocardial function .

Drinking causes diuretic effects, etc., which can lead to the lack of these substances, certain substances added to alcoholic beverages, such as lead (usually contained in "moonlight" wine) or cobalt, which also poison the heart muscle. Cardiomyocytes are the basic unit of the heart. With contractile and diastolic properties, drinking alcohol can cause myocardial cell and myocardial interstitial fibrosis, resulting in myocardial contraction and diastolic function.

The study found that approximately half of asymptomatic heavy drinkers were confirmed by echocardiography with left ventricular hypertrophy, diastolic function, and up to 30% of asymptomatic long-term drinkers with ultrasound confirmed left ventricular systolic dysfunction. If you continue to drink a lot, some people will develop alcoholic cardiomyopathy, heart enlargement, heart failure, palpitations, hernias and arrhythmias, etc. The most common arrhythmia is atrial fibrillation.

an examination

Related inspection

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The X-ray shows that the heart shadow is enlarged, and the heart-thorax ratio is >55%. Electrocardiogram left ventricular hypertrophy is more common, may have atrial fibrillation or frequent premature contraction. Echocardiography or left ventricular angiography showed an enlarged ventricular lumen with a reduced ejection fraction. If you can rule out other heart diseases and have a large history of drinking (the amount of pure ethanol is about 125ml / d, that is, about 4 bottles of beer per day or 150g of white wine), the disease should be considered for more than 10 years. However, the prolonged prolonged prolonged abstinence is not good. At the same time, attention should be paid to the diagnosis and treatment of often combined liver and brain alcoholism.

Differential diagnosis

The differential diagnosis of the first hypertension :

1. Ischemic cardiomyopathy: Ischemic cardiomyopathy is a thorny problem in the surgical treatment of coronary heart disease. Because most of these cardiomyopathy are due to coronary artery multi-vessel disease, even diffuse lesions, extensive myocardial ischemia, degeneration, necrosis and fibrosis, and also doped with myocardial stunning and hibernating myocardium, leading to severe myocardial function Abnormalities, spherical enlargement of the heart and/or heart failure. Ischemic heart disease includes coronary artery obstruction or stenosis caused by atherosclerotic lesions. Myocardial ischemia-induced left ventricular aneurysm, ventricular septal defect after myocardial embolization and mitral regurgitation caused by papillary muscle ischemia are common multiple congenital heart disease in middle-aged and elderly people.

2, alcoholic liver disease: alcoholic liver disease (alcoholic liver disease (ALD), including fatty liver, alcoholic hepatitis, liver fibrosis, cirrhosis and hepatocellular carcinoma. About 2/3 of alcoholics can develop alcoholic liver disease. After the ethanol enters the liver cells, it is oxidized by liver alcohol dehydrogenase, hydrogen peroxide decomposition enzyme and liver microsome ethanol oxidase to form acetaldehyde. Acetaldehyde has obvious toxic and side effects on hepatocytes, which hinders metabolism and leads to degeneration and necrosis of hepatocytes.

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