home Audience 3 Symptoms and treatment of alcoholic cardiopathy. About a heart that “does not want peace.” Clinic and forms of the disease

Symptoms and treatment of alcoholic cardiopathy. About a heart that “does not want peace.” Clinic and forms of the disease

Alcohol has the strongest Negative influence on the human body. Under its influence, various neurological damages are formed, which in some cases cannot be treated. The effect of toxic substances on the heart is also negatively reflected. The muscles of the organ become weak and flabby over time. Subsequently, it arises.

Half of patients who regularly drink alcohol develop alcoholic cardiomyopathy. Middle-aged men often suffer from the disease.

The process of developing cardiomyopathy is quite long. On average, the first signs begin to appear 10 years after you start drinking alcohol on a regular basis. Wherein daily dose ethanol entering the body during this period of time is approximately 100 ml. In 10–20 percent of cases it leads to fatal outcome due to cardiac dysfunction.

What is alcoholic cardiomyopathy?

In 1957, a term was proposed to denote not one, but a whole group of diseases leading to myocardial damage. However, the condition itself was known long before its registration official name. The first description of alcoholic cardiomyopathy (ACMP) dates back to the mid-19th century. It contains a reference to the life of the Germans, famous beer lovers who consumed an average of 430 liters of foamy drink per year per capita. According to the International Classification of Diseases, alcoholic cardiomyopathy has ICD-10 code I42.6.

ACM is a disease that arose from the abuse of ethanol-containing drinks and is characterized by the following pathogenetic features:

systolic dysfunction of the cardiac cavities;
expansion of the cardiac cavities, accompanied by myocardial hypertrophy;
accumulation of adipose tissue occurs in the epicardium.

Changes in the coronary arteries are usually not recorded or are extremely weak. The disease belongs to secondary cardiomyopathies that develop against the background of toxic damage.

Causes of heart dysfunction due to alcohol abuse

The main reason leading to the development of alcoholic cardiomyopathy is the cardiotoxic effects of ethanol. There are several possible mechanisms for the effect of alcohol on the heart. Among them:

The effect of alcohol on the cardiovascular system

What happens to the heart?

Regardless of the mechanism that led to the development of alcoholic cardiomyopathy, harmful effects ethanol leads to heart failure. In this case, demodeling (destruction) of the organ is recorded, expressed in:

changes in the contractile function of heart cells;
formation of functional asymmetry of cardiomyocytes;
interstitial fibrosis (compaction connective tissue formed against the background of the inflammatory process):
deformations of the heart cavities.

Gradually, the walls of the ventricles become harder and lose their elasticity. Against the background of rising end-diastolic pressure and poor filling of the organ with blood, diastolic dysfunction develops. In addition, there is a gradual weakening of the walls of the valves, including the mitral valve. This becomes the reason leading to the expansion of the cavities of the heart. In some cases, this leads to pulmonary hypertension.

Symptoms of the disease

To fully understand the disease, it is not enough to know the name alcoholic cardiomyopathy, what it is and what the mechanism of development is. It is extremely important to understand the symptoms of ACPM. It is especially advisable to study them for people suffering from alcohol addiction and their relatives.

Establishing a diagnosis does not require consultation with a psychiatrist or narcologist and occurs on the basis of an examination conducted by a cardiologist. Alcoholic cardiomyopathy has the following symptoms:

Pain in the chest. Localized in the heart area. In some cases, the pain radiates to lower jaw or under the shoulder blade. It has a cutting, aching, pulling, stabbing character. The sensations continue for quite a long time.
Feelings of squeezing or constriction in the chest. One of the most common symptoms of ACPM. It is registered in almost half of patients. In particular severe cases causes breathing difficulties.
Heaviness behind the sternum.
Pain at the apex of the heart. The zone is located approximately at the intersection of the fifth rib with a conventionally drawn line running a few centimeters to the left of the center of the collarbone. Rarely has pronounced sensations. Exacerbation occurs after drinking alcohol.
The appearance of shortness of breath. The patient complains of lack of air, rapid breathing, inability take a deep breath. The symptom worsens after physical activity, fast walking, running. The intensity of activity can be quite low. The symptom intensifies in supine position.
Violations heart rate. There are interruptions in the functioning of the organ, expressed in an uneven pulse, periodic dizziness and a feeling of “fading” of the heart.
Characteristic external signs talking about alcoholism. Among them are pronounced dilated capillaries, Dupuytren's contracture (impaired ability to flex and straighten fingers caused by overdevelopment connective tissue), swelling, puffiness and others.

Signs of alcoholic heart damage

Treatment of the disease

Alcoholic cardiomyopathy, which is treated comprehensively, in some cases recedes. It is considered competent to conduct therapy simultaneously in three main areas:

Complete cessation of use alcoholic drinks.
Preventive measures to prevent the development of heart failure or its treatment. In this case, the therapy does not differ from that used for heart failure of any other etiology.
Restoration of the metabolic process disturbed due to alcoholism. Most often, the patient is prescribed trimetazidine, phosphocreatine and other medications. They provide positive influence during the Krebs cycle and allow you to restore metabolism.

With alcoholic cardiomyopathy it is possible surgery. Cardiomyoplasty is often performed. IN advanced cases resort to heart transplantation. However, such a radical solution not only has an impressive cost, but also requires a donor organ, which significantly complicates the operation.

Lifestyle change

If the patient continues to drink alcohol, then all therapy loses its effectiveness and all its meaning. In this case, progressive alcoholic cardiomyopathy will cause death.

Besides, important role compliance with the basic rules plays a role healthy image life:

rejection of bad habits;
adherence to sleep and rest patterns;
good nutrition;
balanced physical activity.

Probability of death with alcoholic cardiomyopathy

The consequences of the diagnosis and alcoholic cardiomyopathy itself are the cause of death for half of people suffering from this disease. ACM is the main factor leading to death in patients with alcoholism. Average similar cases are registered in 20 percent of patients.

The disease is known for its unpredictability. Alcoholic cardiomyopathy is fatal (instantaneous in 35 percent of cases), which is often difficult to predict.

Possible complications

Alcoholic cardiomyopathy (ICD 10 code I42.6) has a number of complications. The most common:

and ventricles (can be fatal, manifested in the form of weakness, poor health and increased heart rate to 200 beats per minute);
thromboembolism (formation of blood clots with the likelihood of their subsequent separation and blockage of blood vessels, in many cases leading to the death of the patient).

Useful video

How alcohol consumption affects the cardiovascular system, watch this video:

Conclusion

ACM is a common disease that kills more and more people every year.
On this moment There is no proven treatment method.
Timely measures can reverse the negative consequences for the body. The priority is to completely abstain from alcohol.

From time immemorial, people have resorted to alcohol to relieve emotional stress, relax, forget current difficulties or celebrate some joyful event. Indeed, sometimes skipping a glass - another alcoholic drink will not hurt. But, unfortunately, it often happens that at first a person drinks alcohol occasionally, a couple of times a month, then more and more often, a couple of times a week, then daily. Subsequently, alcohol does not bring any euphoria or relaxation, but only aggravates health problems. We won't dwell on the problem. pathological cravings to alcohol, but let’s just consider some aspects negative influence alcoholic drinks on the human body. Let's look at the bottom of the glass in which a person drowns his troubles and joys?

Ethanol contained in any alcoholic drink is absorbed into the blood within a few minutes and, under the influence of enzymes, is processed in the body into a very toxic substance - acetaldehyde. This substance cannot be immediately excreted from the body, but circulates from five to eight hours in the vascular bed. It is clear that during this time alcohol has a damaging effect on the internal delicate lining of blood vessels (endothelium), on inner shell heart (endocardium) and cardiac muscle (myocardium). If a person pours alcohol on a small scratch or wound on the skin, it will cause discomfort– the wound stings or may cause severe pain. It is not difficult to guess that alcohol in large quantities with constant use, it simply “corrodes” the blood vessels and heart from the inside.

Meanwhile, scientists have proven that daily consumption of one to three doses of alcohol (10 - 30 grams of pure ethanol) can reduce the risk of heart disease. vascular diseases and cardiac death. This phenomenon is called the “French paradox”, since in France it is customary to drink red and dry wines every day. Considered safe daily use dry wine in a dose not exceeding 240 ml, cognac and vodka - 75 ml. For women, the indicated dosages must be halved due to the greater toxicity of alcohol in the female body.

In Russia, the statistics are different, connected primarily with the peculiarities of our mentality. Russian people, as a rule, do not know any sense of proportion in the use of alcoholic beverages, all the more often they resort to the help of strong alcoholic drinks (vodka, cognac, moonshine) in doses exceeding harmless ones. In addition, recently it has become increasingly popular frequent use beer in large quantities by men, women, and even teenagers. People mistakenly believe that if beer is not a strong alcoholic drink, then it cannot do any harm. However, beer contains, in addition to ethanol, many other dangerous substances, such as cobalt, which is added to improve foaming. Cobalt compounds have a direct damaging effect on the myocardium.

With systematic alcohol consumption, the brain, heart and liver suffer the most. With prolonged damage to the heart by the products of ethanol metabolism, alcoholic cardiomyopathy develops in the body.

Causes of the disease

Alcoholic cardiomyopathy is a disease that develops when regular use alcohol and caused by destruction cellular structures and metabolic disorders in the cells of the heart muscle with their subsequent structural restructuring, as well as characterized by expansion of the chambers of the heart and manifested by symptoms of cardiac arrhythmias and heart failure. It is observed in 50% of patients who drink alcohol daily in quantities of more than 150 ml in terms of pure ethanol, more often in males aged 45–50 years.

Signs of myocardial damage most often develop within at least ten years of systematic alcohol abuse, but can develop after 4–5 years. Often heart damage develops faster than liver cirrhosis and is accompanied by damage to the nervous system with alcoholic psychoses, “delirium tremens”, etc.

The development of cardiomyopathy can also be influenced by the patient’s risk factors, such as obesity, hypertension, coronary heart disease, diabetes mellitus, and a family history of sudden cardiac death.

Symptoms of alcoholic cardiomyopathy

The first symptoms of the disease may appear as early as 4–5 years after systematic alcohol abuse. Clinical manifestations may vary depending on the stage of the process:

1. On stages of functional disorders, which can last over ten years, patients note the following symptoms:
- autonomic disorders of the blood vessels and nervous system– sweating, feeling hot, trembling hands, coldness of the skin of the extremities, persistent redness of the skin of the face, emotional arousal or lethargy, sleep disturbances,
- from the side of the heart– a feeling of lack of air, persistent pain in the heart not associated with physical activity, occipital headaches, nausea and vomiting associated with high blood pressure,
- symptoms of transient or persistent arrhythmias- a feeling of freezing, “turning over” of the heart, a feeling of cardiac arrest followed by rapid heartbeat are characteristic of ventricular extrasystole; a sudden acceleration of the heart rate with a frequency of more than 120 per minute may be symptoms of atrial fibrillation or ventricular tachycardia. Arrhythmias can occur suddenly and cause severe discomfort (paroxysmal forms) or exist constantly - permanent forms.

2. Persistent hypertrophy (increase in mass) or dilatation (widening of the chambers) of the heart. It manifests itself as signs of blood stagnation in the heart and internal organs, and severe heart failure develops. The development of failure is also due to rhythm disturbances, which by this time become persistent and lead to wear and tear of the myocardium. Characteristic symptoms:
- constant shortness of breath with the slightest physical activity and at rest,
- swelling of the face, legs and feet,
- bluish discoloration of the fingertips, nose, ears, expanded capillary network on the nose (red veins and “blue” nose),
- urinary disorders due to circulatory problems in the kidneys,
- enlargement of the abdomen due to stagnation of blood and swelling of the liver parenchyma,
- neurological symptoms due to encephalopathy and venous stagnation in the brain - aggression, irritability, anger, trembling hands, unsteady gait, insomnia.

3. Severe dystrophy of the myocardium and all internal organs . Changes in internal organs are caused not only by the inability of the heart to pump blood throughout the body, which causes circulatory disorders at the level the smallest vessels in each organ and oxygen starvation of cells, but also by the direct toxic effect of ethanol on cells. Death of liver, brain, kidney, and pancreas cells occurs. Clinically, this is manifested by severe exhaustion of the patient, swelling of the skin of the arms, legs, face, swelling of the internal cavities of the body (ascites, hydrothorax). The patient is worried about severe shortness of breath at rest, an obsessive suffocating cough, frequent episodes of cardiac asthma with the inability to breathe when lying down, and low blood pressure. Chronic alcohol poisoning and depletion of the heart muscle lead to significant circulatory disorders and the death of the patient.

Diagnosis of alcoholic cardiomyopathy

For each patient with this disease, a consultation with a psychiatrist - narcologist is required to choose optimal treatment alcohol addiction. Patients often hide their addiction, so if alcoholic heart damage is suspected, the doctor should interview the patient’s relatives.

Suspect alcoholic heart damage when clinical picture confirmed by echocardiography, it is possible with negative rheumatological tests, normal level hormones thyroid gland and adrenal glands, that is, with the exception hypertrophic cardiomyopathy caused by heart defects, dyshormonal, post-myocardial and other cardiomyopathies, especially if the patient does not deny the fact of constant drinking.

To clarify the degree of cardiac dysfunction, the following methods are used:
- echocardiography – used to determine the size of the heart, the volume of the cardiac chambers, and the thickness of the myocardium. With alcohol damage, dilation of the chambers with an increase in their volume is more often observed than hypertrophy (thickening) of the myocardium. Characterized by a decrease in ejection fraction (less than 55%) and a general decrease in myocardial contractile function.
- ECG, daily Holter monitoring, ECG with dosed physical activity, ECG after transesophageal electrical stimulation of the heart - are used to clarify the nature of heart rhythm disturbances.
- X-rays of the chest organs may show a clear increase in the shadow of the heart, as well as signs of venous congestion in the lungs (increased pulmonary pattern).
- in a general blood test there may be a slight or pronounced decrease in hemoglobin (anemia); in a general urine test, protein and bilirubin may appear due to alcohol damage to the kidneys and liver and venous stagnation in them.
- V biochemical analysis blood, a decrease in total protein, an increase in bilirubin, an increase in liver enzymes (ALAT, AST) and renal parameters(urea, creatinine), increase alkaline phosphatase. There are no specific markers for alcohol-related illness.
- Ultrasound of the liver, pancreas, kidneys reveals disorders of varying degrees - from the lungs diffuse changes to liver cirrhosis and pancreatic necrosis (“death” of the pancreas)
- Ultrasound of the thyroid gland and adrenal glands in combination with hormonal studies blood tests can reveal disorders that lead to the development of dishormonal cardiomyopathy, that is, they help in differential diagnosis.

Treatment of alcoholic cardiomyopathy

The main principle of treating the disease is complete abstinence from alcohol. It has been proven that stopping the consumption of alcoholic beverages stops the progression of cardiac dysfunction, liver cirrhosis and pancreatic damage. But regression of symptoms is observed only on early stages cardiomyopathy. Naturally, at the third stage, the functions of the heart are already so impaired that it seems possible to maintain its functioning only with the help of long-term and continuous use of medications.

At the first stage of the disease, the following groups of drugs are sufficient:

Vitamins, microelements and cardioprotectors improve metabolic processes in the cells of the heart muscle, normalize heart rhythm, eliminating unpleasant symptoms tachycardia. These include vitamins A, E, C, B vitamins (cyanocobalamin, pyridoxine, thiamine, riboflavin), nicotinic and folic acid; potassium and magnesium preparations (panangin, asparkam, magnerot); Mexidol, Actovegin courses.
- for normalization blood pressure and to prevent rhythm disturbances, antihypertensive drugs (enalapril, Prestarium, Noliprel, etc.) and antiarrhythmics (cordarone, anaprilin, propranolol, etc.) are used.

In the second and third stages, the following are additionally prescribed:
- diuretics – diuretics (indapamide, Lasix, veroshpiron, etc.),
- cardiac glycosides (digoxin, korglykon) are indicated for continuous use in case of permanent tachyarrhythmias, as well as intravenously for the relief of arrhythmia paroxysms in an ambulance or hospital setting. Exceeding the dose prescribed by the doctor is unacceptable due to the development of a cardiotoxic effect (glycoside intoxication).

In addition, for concomitant coronary heart disease, obesity and cholesterol metabolism disorders, the following are indicated:
- statins - drugs that normalize cholesterol levels in the blood - atorvastatin, rosuvastatin, etc.
- nitrates – nitroglycerin under the tongue, nitrosorbide, pectrol, cardiquet for long-term use
- antiplatelet agents and anticoagulants (aspirin, ThromboAss, acecardol, aspicor, warfarin, Plavix, etc.) prevent the formation of blood clots and the development of thromboembolic complications.

Lifestyle with alcoholic cardiomyopathy

1. Proper varied nutrition:
- complete abstinence from alcohol!, smoking limitation,
- a sufficient intake of proteins from food is recommended (90–100 grams per day in a 50/50 ratio of animal and plant origin), fats (70 – 80 g per day) and carbohydrates (300 g per day)
- 4 – 6 meals a day in small portions,
- preference is given to dishes prepared in steam, stewed, boiled form, fried dishes are excluded,
- fatty, salty, spicy foods are excluded,
- limited to eggs, lard, margarine, fatty meats and poultry, confectionery, chocolate, coffee,
- liquid consumption is limited to no more than 1.5 liters per day, table salt to no more than 3 grams per day,
- welcome fresh fruits, berries and vegetables, freshly squeezed juices, fruit drinks, jelly, compotes, low-fat varieties meat, fish and poultry, sea fish(salmon, mackerel), wholemeal bread, cereal products, dairy products, potato.
2. Sufficient physical activity– walking, fishing, mushroom and berry picking
3. Getting enough sleep- at least 8 hours of sleep at night, rest in daytime days
4. Limitation stressful situations , exclusion of heavy physical labor
5. Course or continuous use of drugs as prescribed by the attending physician

Complications of alcoholic cardiomyopathy

Patients with alcoholic myocardial damage may develop:
- life-threatening arrhythmia– ventricular fibrillation, in the absence medical care leading to cardiac arrest. Clinically manifested by a sudden deterioration in health, a very rapid pulse (more than 200 per minute), after a few seconds or minutes, followed by its absence with cessation of breathing and cardiac activity. Prevention is a timely visit to a doctor if heart failure occurs and taking antiarrhythmic drugs prescribed by a doctor.
- thromboembolic complications often develop with cardiomyopathy due to the formation of blood clots in blood slowly moving through the chambers of the heart. A thrombus can “break away” from the wall of the heart and be carried by blood flow to the arteries of the brain, kidneys, coronary arteries, mesenteric, femoral artery. In such cases, ischemic stroke, acute renal failure, myocardial infarction, intestinal necrosis, and thrombosis of the arteries of the lower extremities will develop, respectively. These diseases can be fatal or lead to loss of health and disability of the patient. Prevention - taking anticoagulants and antiplatelet agents as prescribed by the attending physician.

Forecast

Forecast at complete refusal from alcohol, timely detection of the disease (in the first – second stages) and timely initiation of treatment is favorable.

If the patient continues to drink alcohol even at the third stage of the disease, he significantly shortens his life expectancy. Mortality in the first 5–6 years from the onset of clinical manifestations is 40–50%. 12 – 22% of alcoholics die precisely because of cardiomyopathy. In 35%, cardiomyopathy leads to sudden cardiac death.

Temporary incapacity for work sick leave for working citizens it is determined for a period requiring examination and treatment in a hospital (10 - 14 days), for complicated forms - up to three months. If after this time the work prognosis is questionable, the patient is sent to MSEC to determine the disability group. If a patient develops stage II A or higher of chronic heart failure, he may be assigned disability group I or II. For working citizens with III (working) group, working conditions should not be difficult - heavy work is prohibited physical labor, work at night, two or more work shifts in a row, going on business trips, work that involves being at heights (painters, window cleaners), long walking (postmen, couriers). Naturally, persons with alcohol addiction are prohibited from working in socially significant areas (public transport drivers, pilots, train drivers, electric trains, etc.).

General practitioner Sazykina O Yu.

The term “alcoholic cardiomyopathy” is not entirely correct. In modern cardiology, cardiomyopathy is understood as a myocardial disease of unknown cause, characterized by an enlarged heart and progression of heart failure. Therefore, it is correct to talk about alcoholic myocardial dystrophy. This heart damage occurs in people who abuse alcohol and is characterized by metabolic disorders in the cells of the heart muscle.

Development mechanism

Alcohol has a toxic effect on the heart muscle.

Alcohol (ethanol) and its breakdown product, acetaldehyde, have toxic effect on cardiac muscle cells. Energy metabolism is disrupted in them, and the formation of “fuel” for biological reactions – adenosine triphosphate (ATP) – is reduced. In addition, potassium and potassium suffer, which disrupts myocardial contractility.
Ethanol and acetaldehyde cause an increase in the concentration of catecholamines (for example, norepinephrine) in the blood, which increases the myocardial oxygen demand. Catecholamines directly damage cell membranes, activate lipid peroxidation and thereby contribute to the destruction of heart cells.

Clinical forms

Description clinical forms alcoholic myocardial dystrophy was given in 1977 by E. M. Tareev and A. S. Mukhin.

Classic shape. The patient has typical chronic alcoholism. He is bothered by heart pain, especially at night, shortness of breath, and rapid heartbeat. There are interruptions in the functioning of the heart. These symptoms sharply intensify 2-3 days after taking large quantity alcoholic drinks.
Pseudo-ischemic form. The patient complains of pain in the heart area. They can be of varying duration and strength, and may or may not be associated with physical activity. Heart pain must be differentiated from manifestations of ischemic heart disease. Alcoholic myocardial dystrophy is characterized by slight increase body temperature, enlarged heart, development of circulatory failure (shortness of breath, swelling). Pain is often accompanied by rhythm disturbances.
Arrhythmic form. Rhythm disturbances come to the fore - atrial fibrillation, extrasystole, paroxysmal tachycardia, which manifests itself rapid heartbeat, interruptions in heart function, and sometimes dizziness, even episodes of loss of consciousness. In this case, the patient experiences an enlarged heart and shortness of breath.

Clinical stages

The stages during alcoholic myocardial dystrophy were described in detail by V. Kh. Vasilenko in 1989.

Stage 1 lasts up to 10 years and is characterized by episodic heart pain and sometimes rhythm disturbances.
Stage 2 develops in patients with chronic alcoholism with “experience” of more than 10 years. Heart failure appears - swelling in the legs, cough. Patients begin to develop blueness of the face, lips, and hands and feet (acrocyanosis). Dyspnea in such patients may worsen when lying down, which indicates stagnation of blood in the pulmonary circulation. Stagnation of blood in big circle blood circulation is manifested, among other things, by an enlarged liver. Atrial fibrillation () and other serious rhythm disturbances develop.
Stage 3 – severe circulatory failure. There is a violation of the function of internal organs, an irreversible change in their structure.

Symptoms

Symptoms of alcoholic myocardial dystrophy are most pronounced during the abstinence period (within 8 days after an episode of excessive alcohol consumption).

Pain. Pain in the heart area is not associated with physical activity. They appear in the morning, mostly stabbing, aching, and long-lasting. Pain is felt in the area of the apex of the heart (approximately at the intersection of the 5th rib and a conventional vertical line passing 1–2 cm to the left of the middle of the left clavicle). Usually the pain is not intense. It does not go away after taking nitroglycerin. Gain pain syndrome observed after an episode of alcohol abuse.
Dyspnea. The patient is bothered by frequent shallow breathing and a feeling of lack of air, which intensifies even with light exertion. On fresh air health improves.
Interruptions in the functioning of the heart. The patient may be disturbed by the feeling of interruptions, “fading” of the heart, irregular pulse, and episodes of dizziness. The electrocardiogram may record supraventricular or ventricular extrasystole, atrial fibrillation and flutter, paroxysmal supraventricular tachycardia. Rhythm disturbances are especially pronounced in people with severe damage hearts.
Edema, enlarged liver. These are signs of progressive heart failure. It is also characterized by shortness of breath with little physical exertion and at rest. Shortness of breath worsens when lying down, so the patient takes a semi-sitting position. This forced position is called orthopnea.

Swelling in the legs occurs, especially in the evening, and in severe cases, widespread swelling of the entire body and an enlarged abdomen (ascites). The liver enlarges.

Diagnostics

Methods for diagnosing alcoholic cardiomyopathy are standard: ECG, echo-CG, functional tests.

To diagnose alcoholic myocardial dystrophy, electrocardiography, echocardiography ( ultrasonography heart), daily electrocardiogram monitoring, stress test (for example, bicycle ergometry or treadmill test). A consultation with a narcologist is required to confirm the diagnosis of chronic alcoholism.

Treatment

The main therapeutic factor is cessation of alcohol consumption.
To improve metabolic processes in the myocardium, drugs are prescribed that stimulate protein synthesis in heart cells (Mildronate), as well as improve energy metabolism (Cytochrome C, Neoton, etc.). Multivitamins are used for the same purpose.
To suppress lipid peroxidation in cell membranes and stop their damage, antioxidant agents, such as vitamin E, are prescribed.
With the development of certain types of arrhythmias, calcium antagonists (for example, Verapamil) are prescribed. It affects calcium metabolism in cells, providing an antiarrhythmic effect. In addition, these drugs improve tissue respiration, normalize the relaxation of myocardial cells, and stabilize cell membranes.
To stabilize lysosomal membranes, Essentiale or Parmidine are prescribed. As a result, the release of aggressive lysosomal enzymes into the cells and the death of myocardiocytes are prevented.
To eliminate oxygen starvation and “acidification” of the internal environment of the body, patients with alcoholic myocardial dystrophy are recommended to stay in the fresh air, take oxygen cocktails, inhalation of humidified oxygen, sessions hyperbaric oxygen therapy. In addition, antihypoxants are prescribed (for example, Mexidol).
To normalize the electrolyte balance, the body is saturated with potassium salts. A potassium diet is prescribed. It may be recommended to take potassium chloride orally along with orange or tomato juice. Often, when health deteriorates, potassium preparations are administered intravenously. This is especially important in the presence of rhythm disturbances.
To eliminate the effect of excess catecholamines on the myocardium, beta-blockers (for example, Anaprilin) are prescribed. With the development of heart failure and arrhythmias, treatment of these syndromes is carried out according to appropriate regimens.

Which doctor should I contact?

If symptoms of alcoholic heart damage appear, you should consult a cardiologist. However, treatment will be unsuccessful without treating addiction to alcohol, so the patient needs treatment from a narcologist.

Alcoholic cardiopathy is responsible for almost a quarter of all deaths from alcoholism. Alcoholism is big problem in many countries of the world. This disease is shining example the dangers of such an addiction as alcohol abuse.

Alcoholic cardiopathy practically destroys the heart and is directly dependent on the duration and amount of alcohol consumed. That is why WHO experts warn that its consumption in volumes exceeding 8 liters per year is very dangerous for humans.

Pathogenesis of the disease

In general, alcoholic cardiopathy is a heart disease that is characterized by diffuse destruction of the heart muscle under the influence of alcohol. The basis of the mechanism is the toxic effect of ethyl alcohol on myocardial tissue, which causes an increase in organ volume and heart failure, often combined with coronary artery disease.

Thus, alcoholic cardiopathy is a myocardial dystrophy against the background of an imbalance metabolic process in cardiac muscle cells.

The pathogenesis of the disease is based on a violation energy metabolism under the influence of ethanol and its product - acetaldehyde. Cardiac muscle cells lose an essential component - adenosine triphosphate. At the same time, the contractile ability of the myocardium deteriorates due to changes in the metabolism of calcium, potassium and magnesium.

Alcohol products increase the content of catecholamines (including norepinephrine) in the blood, which leads to a lack of oxygen for the myocardium. Catecholamines directly destroy cell membranes, accelerate lipid oxidation and are thus directly involved in damage to cardiac structure.

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Symptoms of pathology

Symptoms of alcoholic cardiomyopathy differ somewhat depending on the type of myocardial dystrophy. The classic form of the disease manifests itself against the background chronic alcoholism. The following signs appear:

pain in the heart area (increases at night);
dyspnea;
increased heart rate.

At some point, there is a feeling of interruptions in the functioning of the heart. Symptoms are most noticeable 2-3 days after drinking a large dose of alcohol.

The pseudoischemic form is characterized by:

heart pain of varying strength and duration;
slight rise in temperature;
shortness of breath;
swelling of the limbs;

The third, arrhythmic form brings to the forefront atrial fibrillation, extrasystole, tachycardia, which cause dizziness and sometimes loss of consciousness.

According to the degree of its development, cardiomyopathy is divided into three stages with their own characteristic symptoms.

The first stage lasts 10 years and is accompanied by rare short-term heart pain.
Stage 2 identifies people who have suffered from alcoholism for more than 10 years. They exhibit obvious symptoms of chronic heart failure: shortness of breath, cough with sputum, swelling lower limbs. A bluish tint appears on the face and lips, and acrocyanosis of the hands and feet begins. Stagnation of blood circulation in the pulmonary circulation leads to shortness of breath when a person is lying down, and stagnation in the systemic circulation causes an increase in liver volume. A disturbance in the heartbeat rhythm leads to the appearance of atrial fibrillation.
Finally, stage 3 (severe form of the disease) - irreversible damage to the structure of the heart and other organs and vascular tissues. The disease can cause death in a person.

In general, the localization of the symptoms of alcoholic cardiopathy is as follows: pain in the heart does not depend on physical activity, usually occurs in the morning and has an aching or stabbing character that lasts quite a long time. The pain intensifies after drinking alcohol. Interruptions in the functioning of the heart are felt in the form of a fading heartbeat, disturbance of its rhythm, and dizziness. The electrocardiogram shows extrasystole, atrial fibrillation and flutter, as well as supraventricular tachycardia.

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Initial stage of the disease

The first (initial) stage of alcoholic cardiomyopathy in its classical form manifests itself in the form of heart failure - in preclinical and clinical type. The preclinical type of the disease occurs with latent symptoms and is determined only by an echocardiogram.

It is characterized by a decrease in ejection and an increase in diastolic pressure in the left ventricle of the heart. The onset of the disease can be assumed if the pulse above 100 beats per minute persists after eliminating alcohol for 7 days.

Clinical type initial stage manifests itself general weakness and shortness of breath. Tachycardia occurs at rest. May begin to develop arterial hypertension. Stopping alcohol consumption leads to restoration of myocardial function and improvement of general condition.

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Pseudo-ischemic phase of the disease

The pseudoischemic form of alcoholic cardiomyopathy includes heart pain and an electrocardiogram similar to coronary disease. Cardialgia appears on early stage and gradually become more pronounced. The pain is localized mainly in the area of the apex of the heart and is constant. This pain, usually aching, sometimes stabbing, is felt as an intense burning sensation in the area of the heart. Cardialgia at this stage does not have the nature of attacks, is not eliminated by nitroglycerin, and most often appears the next day after drinking too much. Heart pain with alcoholic cardiomyopathy can last for hours, and sometimes for several days. When abstaining from alcohol for a long period, cardialgia stops its activity, but after resuming alcohol intake, it returns along with pain.

– a disease whose pathogenesis manifests itself as a result of prolonged consumption of alcoholic beverages.

Men aged 40-45 years, consuming 150 ml daily. alcohol (equal to 400 g of vodka) - most often suffer from this disease. Women are rarely diagnosed with this condition. Despite this, drinking alcohol in girls can also lead to the development of alcoholic cardiomyopathy.

The first symptoms appear after 10 years of active consumption of alcoholic beverages. Sometimes this line shifts. Under the influence of excess weight, diabetes, the time line shifts by a couple of years.

Scientists have identified groups of people who are most at risk of developing pathology. These include:

Citizens whose activities involve stressful situations.
People who are constantly on diets.
Hereditary factor.
Persons with individual anatomical changes in the structure of the heart.
Citizens who have weakened immune systems.

In the international classification ICD-10 alcoholic cardiomyopathy assigned a code I42.6.

This disease occurs after ethanol damages myocardial cells. Metabolism with the heart muscle is disrupted, the structure of the heart changes, and nerve fibers are affected.

Symptoms of alcoholic cardiomyopathy

Vegetative changes. These include excessive sweating, hand tremors, irritability or lethargy.
Pain in the heart area, shortness of breath, increased blood pressure indicate heart failure.
Heart rhythm disturbances- a feeling of cardiac arrest, its “jumping out”.
During the process of expansion of the chambers of the heart and growth of its volume blood stagnation occurs. As a result, swelling and cyanosis of the fingers and nasolabial triangle appear.
Due to disturbances in the blood flow of the kidneys difficulty urinating occurs.
Aggression, irritability, and insomnia appear.
In a situation where the myocardium is thinned, it occurs loss of the heart muscle's ability to pump blood.

In a situation where the patient long time does not seek help from a doctor, does not fight his addiction to alcohol, appearance And internal state are oppressed. He looks exhausted and may have a yellow tint to the skin (appears with the development of cirrhosis of the liver). These signs of the disease at the initial stage should alert his relatives.

Clinically, there are several forms with different symptoms:

Pseudo-ischemic form. It is characterized by pain in the heart area. Observed from above the heart muscle, it is characterized by constancy. Pain is defined as aching, stabbing, burning. This form is accompanied by changes in the electrocardiogram. A competent doctor – a cardiologist – can help you find the problem and answer the question of what it is in adults.
The classic form has pronounced heart failure. At the initial stage of development, the patient complains of a rapid pulse and general malaise. Further, cirrhosis of the liver and hypertension may occur.
The arrhythmic form is characterized by symptoms of various types of arrhythmias. Heart rhythm disturbances, heart failure, low blood pressure, hypersweating, and weakness are observed here.

Death due to alcoholic cardiomyopathy can be caused by:

The volume of alcohol consumed by patients;
Existing disorders of the cardiovascular system;
Low calcium levels in the myocardium.

Cell death in the brain and pancreas may also occur. As a result, attacks of suffocation, lack of air occur, and blood pressure decreases.

The development of pathology has an unfavorable outcome. Five years after the first symptoms were detected, more than half of the patients had died. Instant death occurs in 35% of cases.

People who experience shortness of breath and impaired kidney function do not associate the problem with alcohol abuse. In order to diagnose the disease in a timely manner, a number of medical studies are necessary. These include rheumatological tests and analysis of hormone levels.

When the test data is acceptable level, the specialist must exclude the possibility of dishormonal, post-myocardial, defect-related cardiomyopathy.

Echocardiography is used for in-depth study of the problem. Data from blood tests, ultrasound of the kidneys, liver, pancreas, and x-ray diagnostics are also taken into account.

In addition, Holter monitoring techniques and stress sampling may be used.

Goals of treatment for cardiomyopathy

Among the goals of treatment of this disease highlight:

cessation of disease development;
elimination of other symptoms accompanying the development of pathology;
prevention of complications leading to death;
increasing the patient's life expectancy.

How can a patient help himself?

It is the consumption of large quantities of alcoholic beverages that is the main cause of the disease.. As a result of smoking, blood vessels contract and blood circulation in the organs is impaired. The amount of air that the myocardium receives decreases, and the load on the heart increases. Combined with alcoholic cardiomyopathy, it is the cause of death.

Alcohol abuse affects the worsening of the disease. Ethanol together with its breakdown products have an adverse effect on the heart.

Clinical guidelines for following the basics proper nutrition- one of the ways to treat the disease. They need to consume protein products. Salt should be excluded. If the patient is overweight, the doctor recommends a daily caloric intake.

Physical activity should be kept to a minimum. Walking and breathing exercises are acceptable.

Drug treatment of cardiomyopathy

Depending on the type of disease, drug treatment aimed at eliminating symptoms.

Medicines are grouped into groups:

Diuretics. These are diuretics that are prescribed to patients. They affect the decrease in blood volume, and, as a result, a decrease in the load on the heart.
ACE inhibitors ( inhibitors angiotensin converting enzyme). Used to stabilize blood pressure. When low blood pressure the load on the left atrium is reduced.
Beta blockers. Medicines included in this group are aimed at reducing heart rate.
Cardiac glycosides– the specialist writes a prescription for their use in case of atrial fibrillation.
Anticoagulants– prescribed in cases of thrombosis.

Surgical treatment of cardiomyopathy

Besides treatment medicines The method of surgical intervention is widely used to eliminate similar disease. Its specificity is related to the type of disease.

Dilated cardiomyopathy

Treatment methods for dilated cardiomyopathy include: cardiomyoplasty. The essence of the procedure is as follows. The surgeon removes a muscle flap from the back muscles and wraps it around the heart. In a similar way, tissues affected by the disease are partially replaced.

Such an operation can increase the life expectancy of patients.

In practice, there are other treatment methods:

For example, dual-chamber electrical stimulation of the heart. The operation is performed on patients with atrial and ventricular fibrillation. Based on the results of the interventions, an electrical stimulator is installed. It improves internal blood flow in the heart muscle.
The next method of eliminating the disease is the installation of an extracardiac mesh frame. It is performed individually, depending on the anatomy of a particular patient. The purpose of this operation is to prevent the growth of the ventricles.
One of the most difficult and radical methods is a heart transplant procedure. Indications for transplantation are the absence or low chances of survival in patients within a year. The prognosis based on the results of the manipulations is conditionally favorable. Due to the fact that there is a waiting list to receive a heart for transplantation, patients do not live to see the operation.

Hypertrophic cardiomyopathy

During surgical procedures to eliminate hypertrophic cardiomyopathy, transaortic septal myotomy (removal of the septum between the ventricles) is used.

Restrictive cardiomyopathy

It appears as one of the less studied subtypes of this disease. Effective treatment not found.

Arrhythmogenic cardiomyopathy

In the treatment of arrhythmogenic cardiomyopathy, the method is used implantation of pacemakers, cardioverters - defibrillators, as well as the method of radiofrequency ablation. The bottom line is that the patient's femoral and subclavian veins are punctured. By introducing electrodes into the heart through installed catheters, arrhythmia occurs.