Alcoholic cardiomyopathy medical therapy: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Alcoholic cardiomyopathy}} | {{Alcoholic cardiomyopathy}} | ||
{{CMG}}; {{AE}} {{HP}} | {{CMG}}; {{AE}} {{RT}}; {{HP}} | ||
==Overview== | |||
Treatment for alcoholic cardiomyopathy involves lifestyle changes, including complete abstinence from [[alcohol]] use <ref name="pmid9164905">{{cite journal|author=Guillo P, Mansourati J, Maheu B, ''et al.'' |title=Long-term prognosis in patients with alcoholic cardiomyopathy and severe heart failure after total abstinence |journal=[[The American Journal of Cardiology]] |volume=79 |issue=9 |pages=1276–8 |year=1997 |month=May |pmid=9164905 |doi= |url=}}</ref><ref name="pmid2131353">{{cite journal |author=Masani F, Kato H, Sasagawa Y, ''et al.'' |title=[An echocardiographic study of alcoholic cardiomyopathy after total abstinence] |language=Japanese |journal=[[Journal of Cardiology]] |volume=20 |issue=3 |pages=627–34 |year=1990 |pmid=2131353 |doi= |url=}}</ref><ref name="pmid3530014">{{cite journal |author=Agatston AS, Snow ME, Samet P |title=Regression of severe alcoholic cardiomyopathy after abstinence of 10 weeks|journal=[[Alcoholism, Clinical and Experimental Research]] |volume=10 |issue=4 |pages=386–7 |year=1986 |month=August |pmid=3530014 |doi= |url=}}</ref><ref name="pmid2125195">{{cite journal |author=Mansourati J, Forneiro I, Genet L, Le Pichon J, Blanc JJ |title=[Regression of dilated cardiomyopathy in a chronic alcoholic patient after abstinence from alcohol] |language=French |journal=[[Archives Des Maladies Du Coeur Et Des Vaisseaux]] |volume=83 |issue=12|pages=1849–52; discussion 1853 |year=1990 |month=November |pmid=2125195 |doi= |url=}}</ref>, a low sodium diet, and fluid restriction, as well as medications. If the [[heart failure]] is severe, the effectiveness of treatment will be limited. | |||
==Medical Therapy== | ==Medical Therapy== | ||
===Abstinence from Alcohol=== | |||
Several studies have shown that abstinence from alcohol, if attempted prior to the onset of fibrosis, resulted in significant improvement in LV function <ref name="pmid8009044">{{cite journal |author=Renault A, Mansourati J, Genet L, Blanc JJ |title=[Dilated cardiomyopathies in severe cardiac failure in chronic alcoholics: clinical course after complete withdrawal] |language=French |journal=[[La Revue De Médecine Interne / Fondée ... Par La Société Nationale Francaise De Médecine Interne]] |volume=14 |issue=10 |pages=942 |year=1993 |pmid=8009044 |doi= |url=}}</ref><ref name="pmid8339663">{{cite journal |author=Nethala V, Brown EJ, Timson CR, Patcha R |title=Reversal of alcoholic cardiomyopathy in a patient with severe coronary artery disease |journal=[[Chest]] |volume=104 |issue=2 |pages=626 |year=1993 |month=August |pmid=8339663 |doi= |url=}}</ref>. | |||
* Demakis et al followed 57 patients with alcoholic cardiomyopathy for over an average of 40.5 months to study the natural course of the disease. It was concluded that a short duration of symptoms before initiation of therapy and abstention from alcohol were associated with a more favorable course <ref name="pmid4273902">{{cite journal |author=Demakis JG, Proskey A, Rahimtoola SH, ''et al.'' |title=The natural course of alcoholic cardiomyopathy |journal=[[Annals of Internal Medicine]] |volume=80 |issue=3 |pages=293–7 |year=1974 |month=March |pmid=4273902 |doi= |url=}}</ref>. | |||
* An echocardiographic study by Masani et al to found an improvement in the left ventricular ejection fraction left ventricular end diastolic dimensions in patients with alcoholic cardiomyopathy if alcohol intake is completely stopped <ref name="pmid2131353">{{cite journal |author=Masani F, Kato H, Sasagawa Y, ''et al.'' |title=[An echocardiographic study of alcoholic cardiomyopathy after total abstinence] |language=Japanese |journal=[[Journal of Cardiology]] |volume=20 |issue=3 |pages=627–34 |year=1990 |pmid=2131353 |doi= |url=}}</ref>. | |||
===Acute Pharmacotherapy=== | |||
* Treatment of heart failure includes restriction of dietary salt and medications like [[ACE inhibitors]] or [[angiotensin II receptor blockers]], [[beta blockers]], [[diuretics]] and [[digoxin]] which are commonly used for other forms of [[cardiomyopathy]] to reduce the strain on the [[heart]]. [[Diuretic]]s can also be used to help remove the excess fluid from the body. Persons with [[congestive heart failure]] may be considered for surgical insertion of an [[ICD]] or a [[pacemaker]] which can improve the heart function. In cases where the [[heart failure]] is irreversible and worsening, a [[heart transplant]] may be considered. Treatment will possibly prevent the [[heart]] from further deterioration, and the [[cardiomyopathy]] is largely reversible if complete abstinence from [[alcohol]] is maintained. | |||
Treatment | * Prophylactic pharmacotherapy with beta-blockers, ACE inhibitors/angiotensin II receptor blockers coupled with abstinence from alcohol have been proven to halt or reverse the pathophysiology in asymptomatic LV dysfunction. | ||
* Treatment of arrhythmias in alcoholic cardiomyopathy should be addressed in the usual way. | |||
* Electrolyte abnormalities like [[hypokalemia]], [[hypomagnesemia]] and [[hypophosphatemia]] should be addressed promptly to prevent the risk of lethal [[arrhythmia]]s and [[sudden death]]. | |||
* Concomitant prevalence of nutritional deficiency is common in alcoholic cardiomyopathy. Therefore, supplementation with [[thiamine]] (200 mg once daily), vitamin B-12, folic acid and minerals should be attempted. | |||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
{{WH}} | |||
{{WS}} | |||
[[CME Category::Cardiology]] | |||
[[Category:Disease]] | [[Category:Disease]] | ||
[[Category:Cardiology]] | [[Category:Cardiology]] | ||
Latest revision as of 19:46, 14 March 2016
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Raviteja Guddeti, M.B.B.S. [2]; Hardik Patel, M.D.
Overview
Treatment for alcoholic cardiomyopathy involves lifestyle changes, including complete abstinence from alcohol use [1][2][3][4], a low sodium diet, and fluid restriction, as well as medications. If the heart failure is severe, the effectiveness of treatment will be limited.
Medical Therapy
Abstinence from Alcohol
Several studies have shown that abstinence from alcohol, if attempted prior to the onset of fibrosis, resulted in significant improvement in LV function [5][6].
- Demakis et al followed 57 patients with alcoholic cardiomyopathy for over an average of 40.5 months to study the natural course of the disease. It was concluded that a short duration of symptoms before initiation of therapy and abstention from alcohol were associated with a more favorable course [7].
- An echocardiographic study by Masani et al to found an improvement in the left ventricular ejection fraction left ventricular end diastolic dimensions in patients with alcoholic cardiomyopathy if alcohol intake is completely stopped [2].
Acute Pharmacotherapy
- Treatment of heart failure includes restriction of dietary salt and medications like ACE inhibitors or angiotensin II receptor blockers, beta blockers, diuretics and digoxin which are commonly used for other forms of cardiomyopathy to reduce the strain on the heart. Diuretics can also be used to help remove the excess fluid from the body. Persons with congestive heart failure may be considered for surgical insertion of an ICD or a pacemaker which can improve the heart function. In cases where the heart failure is irreversible and worsening, a heart transplant may be considered. Treatment will possibly prevent the heart from further deterioration, and the cardiomyopathy is largely reversible if complete abstinence from alcohol is maintained.
- Prophylactic pharmacotherapy with beta-blockers, ACE inhibitors/angiotensin II receptor blockers coupled with abstinence from alcohol have been proven to halt or reverse the pathophysiology in asymptomatic LV dysfunction.
- Treatment of arrhythmias in alcoholic cardiomyopathy should be addressed in the usual way.
- Electrolyte abnormalities like hypokalemia, hypomagnesemia and hypophosphatemia should be addressed promptly to prevent the risk of lethal arrhythmias and sudden death.
- Concomitant prevalence of nutritional deficiency is common in alcoholic cardiomyopathy. Therefore, supplementation with thiamine (200 mg once daily), vitamin B-12, folic acid and minerals should be attempted.
References
- ↑ Guillo P, Mansourati J, Maheu B; et al. (1997). "Long-term prognosis in patients with alcoholic cardiomyopathy and severe heart failure after total abstinence". The American Journal of Cardiology. 79 (9): 1276–8. PMID 9164905. Unknown parameter
|month=ignored (help) - ↑ 2.0 2.1 Masani F, Kato H, Sasagawa Y; et al. (1990). "[An echocardiographic study of alcoholic cardiomyopathy after total abstinence]". Journal of Cardiology (in Japanese). 20 (3): 627–34. PMID 2131353.
- ↑ Agatston AS, Snow ME, Samet P (1986). "Regression of severe alcoholic cardiomyopathy after abstinence of 10 weeks". Alcoholism, Clinical and Experimental Research. 10 (4): 386–7. PMID 3530014. Unknown parameter
|month=ignored (help) - ↑ Mansourati J, Forneiro I, Genet L, Le Pichon J, Blanc JJ (1990). "[Regression of dilated cardiomyopathy in a chronic alcoholic patient after abstinence from alcohol]". Archives Des Maladies Du Coeur Et Des Vaisseaux (in French). 83 (12): 1849–52, discussion 1853. PMID 2125195. Unknown parameter
|month=ignored (help) - ↑ Renault A, Mansourati J, Genet L, Blanc JJ (1993). "[Dilated cardiomyopathies in severe cardiac failure in chronic alcoholics: clinical course after complete withdrawal]". La Revue De Médecine Interne / Fondée ... Par La Société Nationale Francaise De Médecine Interne (in French). 14 (10): 942. PMID 8009044.
- ↑ Nethala V, Brown EJ, Timson CR, Patcha R (1993). "Reversal of alcoholic cardiomyopathy in a patient with severe coronary artery disease". Chest. 104 (2): 626. PMID 8339663. Unknown parameter
|month=ignored (help) - ↑ Demakis JG, Proskey A, Rahimtoola SH; et al. (1974). "The natural course of alcoholic cardiomyopathy". Annals of Internal Medicine. 80 (3): 293–7. PMID 4273902. Unknown parameter
|month=ignored (help)