Alcoholic cardiomyopathy - BMJ Case Reports

BMJ Case Reports: first published as 10.1136/bcr-2013-201449 on 23 October 2013. Downloaded from on 14 October 2023 by guest. Protected by copyright.

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Alcoholic cardiomyopathy

Antonio Mirijello, Gabriele Vassallo, Raffaele Landolfi, Giovanni Addolorato

Department of Internal Medicine, Catholic University of Rome, Rome, Italy

Correspondence to Dr Antonio Mirijello, antonio.mirijello@

DESCRIPTION A 42-year-old man was admitted to our internal medicine unit because of exertional dyspnoea and peripheral oedema. The patient was also experiencing fatigue and reduction in effort tolerance. He denied palpitations or chest pain. Medical history was unremarkable for cardiovascular events; he did not smoke and denied family history of heart disease. However, the patient was found to have a history of alcohol dependence lasting 20 years, with a mean alcohol consumption of 15?20 drinks/ day (1 drink=12.5 g ethanol).

At physical examination he appeared tachypneic. Blood pressure was 140/80 mm Hg, pulse was 90 bpm and respiratory rate was 20 breaths/min. Cardiac examination showed reduced S1, normal S2, moderate systolic murmur (3/6) together with S3. At thoracic examination bilateral signs of pulmonary suboedema were audible. ECG showed sinus rhythm with complete right bundle branch block. Echocardiography showed dilated cardiomyopathy with markedly depressed ejection fraction (25%) and mitral regurgitation. Treatment included furosemide, spironolactone, carvedilol and ramipril. Implantable cardioverter defibrillator (ICD) implantation was also performed.

The patient started a multidisciplinary programme, including counselling and baclofen 10 mg

three time a day, to achieve and maintain total alcohol abstinence at our Alcohol Addiction Unit.1

A chest X-ray performed 1 month after ICD implantation shows typical signs of alcoholic cardiomyopathy (figure 1). The patient has been totally abstinent from alcohol since 3 months.

Alcohol induces several changes in the myocardial structure (myocyte loss, intracellular organelle dysfunction and contractile protein alterations). However, the exact pathogenesis of alcoholic cardiomyopathy is still unclear. Total alcohol abstinence, together with heart failure treatment drugs, results in at least partial recovery of the myocyte damage, with a consequent improvement in cardiac function.2

Learning points

Alcohol misuse is one of the causes of dilated cardiomyopathy.

The exact pathogenesis of alcoholic cardiomyopathy is still unclear.

Treatment must include complete alcohol abstinence together with the treatment of heart failure.

To cite: Mirijello A, Vassallo G, Landolfi R, et al. BMJ Case Rep Published online: [ please include Day Month Year] doi:10.1136/ bcr-2013-201449

Figure 1 Chest X-ray showing signs of alcoholic cardiomyopathy (cardiomegaly, venous vessels enlargement, pulmonary oedema).

Contributors All the authors managed the patient during hospitalisation. AM, GV and GA are currently managing the patient in the Alcohol Addiction Unit. All the authors wrote and revised the manuscript.

Competing interests None.

Patient consent Obtained.

Provenance and peer review Not commissioned; externally peer reviewed.

REFERENCES

1 Addolorato G, Mirijello A, Leggio L, et al. Liver transplantation in alcoholic patients: impact of an alcohol addiction unit within a liver transplant center. Alcohol Clin Exp Res 2013;37:1601?8.

2 Addolorato G, Leggio L, d'Angelo C, et al. Physical considerations for treatment complications of alcohol and drug use and misuse. In: Johnson BA.ed Addiction medicine. Springer Science +Business Media, LLC, 2011, 1115?45. doi:10.1007/ 978-1-4419-0338-9_56

Mirijello A, et al. BMJ Case Rep 2013. doi:10.1136/bcr-2013-201449

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BMJ Case Reports: first published as 10.1136/bcr-2013-201449 on 23 October 2013. Downloaded from on 14 October 2023 by guest. Protected by copyright.

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Mirijello A, et al. BMJ Case Rep 2013. doi:10.1136/bcr-2013-201449

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