Alcoholic Cardiomyopathy

Alcoholic Cardiomyopathy – Treatment Options

Introduction
Alcoholic cardiomyopathy (ACM) is a form of dilated cardiomyopathy caused by chronic, heavy alcohol consumption, typically more than 80–100 g/day for over 5–10 years. It leads to impaired myocardial contractility, chamber dilatation, and eventually heart failure. Patients may present with dyspnea, fatigue, edema, palpitations, and arrhythmias. Early recognition and strict alcohol abstinence can significantly improve outcomes, while continued drinking leads to progressive deterioration and increased mortality.

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1. Lifestyle and Causal Management

• Complete alcohol abstinence:

  • The most important and effective intervention.

  • May lead to partial or full recovery of cardiac function if initiated early.

• Nutritional support:

  • Correct deficiencies (thiamine, folate, magnesium).

  • Encourage a balanced, heart-healthy diet.

• Smoking cessation and regular exercise (as tolerated).

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2. Guideline-Directed Medical Therapy (GDMT) for Heart Failure

• ACE inhibitors or ARBs, or ARNI (sacubitril/valsartan): Improve symptoms, reduce hospitalization and mortality.

• Beta-blockers (carvedilol, metoprolol succinate, bisoprolol): Reduce arrhythmias, improve LV function, and survival.

• Mineralocorticoid receptor antagonists (spironolactone, eplerenone): Added in reduced ejection fraction with persistent symptoms.

• SGLT2 inhibitors (dapagliflozin, empagliflozin): Emerging as standard in HFrEF, improve outcomes regardless of diabetes status.

• Diuretics (loop diuretics like furosemide): For symptomatic relief of fluid overload; not disease-modifying.

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3. Arrhythmia and Device Therapy

• Antiarrhythmic management:

  • Treat atrial fibrillation or ventricular arrhythmias per standard protocols.

  • Anticoagulation as indicated (CHA₂DS₂-VASc score).

• Implantable cardioverter-defibrillator (ICD):

  • Consider in patients with persistently reduced LVEF (<35%) despite ≥3 months of abstinence and optimal therapy.

• Cardiac resynchronization therapy (CRT): For selected patients with wide QRS and reduced EF.

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4. Advanced Therapies

• Left ventricular assist device (LVAD): Bridge to transplant or destination therapy in refractory cases.

• Heart transplantation:

  • Considered for end-stage ACM unresponsive to medical and device therapy.

  • Requires documented long-term alcohol abstinence and psychosocial stability.

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5. Supportive and Preventive Care

• Regular follow-up with echocardiography to assess recovery or progression.

• Psychiatric and addiction support services for relapse prevention.

• Patient and family education on adherence to therapy, diet (low sodium), and fluid management.