Alcoholic cardiomyopathy (ACM) is a heart disease that occurs due to chronic alcohol consumption. It is a type of dilated cardiomyopathy since it involves dilation or enlargement of one of the heart’s chambers.

ACM involves the enlargement of the heart’s left ventricle (LV), the chamber responsible for pumping oxygen-rich blood around the body. An enlarged LV causes the muscles within it to thin and weaken, resulting in impaired heart function. This can cause symptoms such as shortness of breath, palpitations, and fainting.

This article explores ACM and its link to alcohol use disorder (AUD). We also discuss how a person can seek help.

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ACM is a type of heart disease that develops due to chronic alcohol consumption.

In ACM, toxic levels of alcohol damage the heart muscle. The heart’s LV attempts to compensate for this damage by enlarging to achieve a higher blood output. However, as the LV enlarges, its muscular walls begin to thin and weaken. This eventually limits the heart’s ability to pump oxygen-rich blood around the body.

Without an adequate supply of blood and oxygen, the body’s organs and tissues can no longer function properly. This can result in various symptoms, including fluid retention and episodes.

According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), AUD is a brain disorder that doctors characterize by the inability to stop or control alcohol consumption. This inability occurs despite adverse effects on the person’s health, occupation, or relationships. The condition may range in severity from mild to severe.

AUD can cause alcoholic cardiomyopathy. Still, medical professionals have not identified a specific alcohol level toxic to heart cells. They also have not established how long a person would need to consume alcohol before developing ACM.

As a point of reference, consuming 80 grams of alcohol daily for at least 5 years can significantly increase the risk of ACM.

However, not everyone who chronically misuses alcohol will develop ACM. Around 1–2% of those who engage in heavy alcohol consumption have ACM. In addiction centers, this number increases to 21–32%.

Some symptoms of ACM may include:

  • shortness of breath that may:
    • comes on gradually
    • worsen over time
    • wake a person from their sleep
    • be more severe while lying flat and lessen when sitting or standing up
  • heart palpitations
  • fainting

Other possible signs include:

  • weight loss
  • muscle wastage
  • weakness
  • fluid retention and swelling in the extremities
  • bulging of the major veins in the neck

ACM can also induce a feeling of fatigue or a decrease in exercise tolerance. A person may not be able to withstand the amount of exercise or activity as they had previously.

Cardiotoxicity refers to heart damage that occurs in response to certain drugs, such as alcohol. Alcohol-induced cardiotoxicity (AIC) may be acute or chronic.

Acute vs. chronic

Acute AIC can occur following the consumption of a large volume of alcohol. This can cause heart inflammation, leading to an atypically fast heart rhythm, such as atrial fibrillation (AF).

Chronic AIC can occur following alcohol consumption over an extended period. This has a toxic effect on the heart. Scientists believe that this toxicity can trigger the following issues, which may then lead to AC:

  • damage to the mitochondria, which provide energy to the body’s cells
  • oxidative stress
  • cell death
  • changes to proteins that support the heart muscle
  • calcium imbalance in the body

Often, when a doctor suspects cardiomyopathy, they will order an echocardiogram. This test will assess the ejection fraction (EF), a measurement that expresses how much blood the LV pumps out with each contraction. Cardiomyopathy tends to show a reduced EF, usually less than 40%. Once doctors have found this, they will look for the cause of the weakened heart.

A long history of alcohol misuse may likely result in a diagnosis of ACM.

Generally, various tests are necessary to find the underlying cause. For instance, healthcare professionals can carry out a stress test or heart catheterization to rule out coronary artery disease (CAD), which is another cause of cardiomyopathy.

Learn more about tests for cardiomyopathy.

Cardiomyopathy has multiple causes. For some people, a combination of factors could also lead to a weakened heart.

Blood tests looking for the protein troponin can be helpful. Elevations in troponin can signify heart damage or an increase in cardiac output that results in demand ischemia. This is where the heart has an increased need for oxygen that exceeds the body’s ability to supply it.

While it is not specific to any heart damage, elevations in troponin can often prompt a doctor to order further cardiac tests. These may then find any underlying cardiomyopathy.

The primary treatment for ACM involves complete abstinence from alcohol or other drugs. However, some studies show that moderating alcohol consumption may lead to similar health outcomes.

Other lifestyle changes a person will likely need to make include reducing the amount of fluid they drink or salt they eat. That way, they can limit the amount of extra fluid in the body. A person can speak with a doctor about any concerns regarding lifestyle changes.

Individuals will also require treatments for heart failure symptoms and associated complications.

Medical treatment options may include:

  • Beta-blockers: These medications slow heart rate, reduce the heart’s output of blood, and lower blood pressure.
  • Angiotensin converting enzyme inhibitors: These medications help relax and widen the blood vessels, lowering blood pressure.
  • Diuretics: These medications help the body eliminate excess salt and water, thereby reducing fluid retention and blood pressure.

A 2023 article notes that ACM carries a more positive outlook than ischemic cardiomyopathy, which refers to heart damage that typically occurs due to CAD.

People who continue to drink alcohol following a diagnosis of ACM tend to have a more negative outlook. They generally develop complications, such as:

  • progressive heart failure
  • muscle wasting and weakness
  • arrhythmias
  • cardioembolic stroke

Around 40–80% of people with ACM who continue drinking alcohol die within 10 years of their diagnosis.

Individuals who completely quit alcohol generally have improved overall outcomes. They typically require fewer hospitalizations and show improved heart function on ECG readings.

According to the NIAAA, many people with AUD recover, although setbacks are common among those receiving treatment. Seeking professional help early on can help prevent setbacks.

Professional help for AUD may include:

  • behavioral therapies to help people develop skills for identifying, avoiding, and overcoming triggers that may lead to drinking
  • medications to help deter drinking during times of stress

Learn more about AUD treatment.

The NIAAA provides an Alcohol Treatment Navigator, where people can learn about AUD treatments and access care and support networks locally.

Alternatively, a person can talk with a doctor about their drinking. A doctor can guide someone to resources to help them quit drinking and can make referrals.

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 affects the heart’s ability to pump oxygen-rich blood around the body. This can cause various symptoms, including shortness of breath, fluid retention, and fainting.

The primary treatment for ACM is complete abstinence from alcohol, which may require a combination of behavioral therapy and medication. Other treatments aim to treat the symptoms of ACM and prevent any disease complications.

Anyone with concerns about alcohol consumption or heart health needs to consult a doctor for further advice and guidance.