ALCOHOLIC CARDIOMYOPATHY

Clinical observations over the past two decades have pointed to the re lationship between heart disease and alcohol abuse, usually without ev ident malnutrition or cirrhosis. While the prevalence of heart failure in the alcoholic population is now known, subclinical abnormalities o f left ventricular function in noncardiac alcoholics who were normoten sive have a high prevalence with or without some degree of ventricular hypertrophy by echocardiogram. This is frequently a diastolic rather than systolic abnormality. Congestive cardiomyopathy is not infrequent ly associated with high diastolic arterial blood pressures. Intoxicati on itself may contribute to blood pressure elevation. Angina pectoris in the absence of significant coronary disease is another presentation . Although the history may not be readily obtained, the major diagnost ic feature in this entity is the history of ethanol ingestion in intox icating amounts for at least 10 years, often marked by periods of spre e drinking. While the course of congestive cardiomyopathy may be progr essively downhill in individuals who continue to be actively alcoholic after the onset of heart failure, in one series one third of the pati ents became abstinent. These patients had a 4 year mortality that was persistently one-sixth of the alcoholic group. Management of heart fai lure is traditional in these patients. Atrial arrhythmias have been sh own to occur during the early ethanol withdrawal phase in patients wit hout other clinical evidence of heart disease. Sudden death in a segme nt of the alcoholic population is considered arrhythmia related and is commonly associated with cigarette use. Identification of the addicte d individual is the essential element to management.