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The heart's primary function is to pump blood throughout the body, maintaining a balance between blood sent out (cardiac output) and blood returning (venous return). If this balance is disrupted, it can result in congestive heart failure (CHF), a severe condition where the heart becomes an inefficient pump, leading to inadequate blood circulation.
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Heart failure (HF) is a progressive syndrome involving ventricles that leads to inadequate cardiac output. It can be classified based on location and output or ejection fraction. Ejection fraction (EF) is an essential measurement in the diagnosis and surveillance of HF. Reduced EF corresponds to systolic heart failure (HFrEF). However, HF with preserved ejection fraction (HFpEF) is becoming increasingly prevalent. Also known as diastolic HF, this form of HF is related to aging. The...
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Updated: Jun 24, 2025

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Alcoholic cardiomyopathy: an update.

Fernando Domínguez1,2, Eric Adler3, Pablo García-Pavía1,2

  • 1Department of Cardiology, Heart Failure and Inherited Cardiac Diseases Unit, Hospital Universitario Puerta de Hierro Majadahonda, IDIPHISA, CIBERCV, Manuel de Falla, 2, Majadahonda, Madrid 28222, Spain.

European Heart Journal
|June 7, 2024
PubMed
Summary
This summary is machine-generated.

Alcohol-induced cardiomyopathy (AC) results from heavy alcohol consumption damaging the heart. Abstinence is key for recovery, offering an excellent prognosis for patients with AC.

Keywords:
AlcoholAlcoholic cardiomyopathyPathogenesisTreatment

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Area of Science:

  • Cardiology
  • Toxicology
  • Genetics

Background:

  • Alcohol-induced cardiomyopathy (AC) is an acquired heart condition linked to prolonged, heavy alcohol intake.
  • The precise definition of alcohol consumption leading to AC remains debated, though >80 g/day over 5 years is often cited.

Purpose of the Study:

  • To review the pathogenesis of alcohol-induced cardiomyopathy.
  • To explore the mechanisms, genetic factors, and contributing conditions involved in AC development.
  • To discuss the natural history and treatment strategies for AC, emphasizing alcohol abstinence.

Main Methods:

  • This review synthesizes current research on alcohol-induced cardiomyopathy.
  • It examines the direct toxic effects of ethanol and its metabolite, acetaldehyde, on the myocardium.
  • Genetic predisposition, particularly titin-truncating variants, and synergistic effects with other conditions are considered.

Main Results:

  • Ethanol induces oxidative stress and activates the renin-angiotensin system.
  • Acetaldehyde impairs cardiac function by affecting actin-myosin interaction and causing mitochondrial dysfunction.
  • A 'double-hit' hypothesis suggests AC arises from combined genetic and environmental (alcohol) factors.

Conclusions:

  • Alcohol abstinence is the most critical intervention for AC, leading to significant left ventricular ejection fraction recovery and improved prognosis.
  • While AC shares similarities with other dilated cardiomyopathies, its course is heavily influenced by alcohol cessation.
  • Future treatments may target specific pathogenic pathways of AC, potentially improving outcomes beyond current heart failure guidelines.