Inflammatory cardiomyopathy is the inflammation of myocardium that presents with a variety of symptoms. Inflammatory cardiomyopathy leads to degeneration and/or necrosis of myocytes in a healthy individual, which can cause arrhythmia or progressive heart failure. About 1-10 out of 100,000 people are affected in the United States. There is no gender predilection for inflammatory cardiomyopathy; however, younger males are commonly susceptible to it. Furthermore, neonates, pregnant women and immunocompromised patients are particularly susceptible. The median age depends on the type of inflammatory cardiomyopathy, for example, median age for lymphocytic inflammatory cardiomyopathy is 42 years; whereas mean age for giant cell inflammatory cardiomyopathy is 58 years.
Inflammatory cardiomyopathy is classified by Lieberman as acute, fulminant, chronic active and chronic persistent Inflammatory cardiomyopathy. All these forms of inflammatory cardiomyopathy, except chronic persistent inflammatory cardiomyopathy have ventricular dysfunction that leads to cardiomyopathy. (2)
Effects Of Alcohol On Inflammatory Cardiomyopathy Patients
Alcohol consumption has been associated with a number of cardiovascular diseases. The symptoms of alcoholic cardiomyopathy are similar to dilated cardiomyopathy and include dyspnea, orthopnea, paroxysmal nocturnal dyspnea, weakness, fatigue, chest discomfort, syncope, dizziness, palpitations, anorexia, generalized cachexia, cool extremities, and muscle atrophy. It can lead to hypertension, arrhythmias, stroke, heart failure and sudden death. People with chronic abuse of alcohol have increased chances of having left ventricular dysfunction in about 33% cases of dilated cardiomyopathy. Ethanol and its metabolites are the main causative agents that have been implicated in direct toxicity of myocardium. However, some evidence suggests increase in blood pressure, nutritional deficiencies such as thiamine deficiency and secondary exposures like arsenic, tobacco and cobalt too. Chronic alcohol use can also lead to damage of mitochondrial DNA, which increases the chances of mutations.
Alcohol intake in excess can lead to increased systemic blood pressure that can cause chronic myocardial dysfunction. Heavy drinking has been associated with systemic inflammatory reaction leading to alcohol induced myocardial inflammation. It is believed that clinically applicable effect on myocardium is seen after minimum of 10 years of excessive alcohol consumption. Drinking more than 2 drinks per day increases the chance of hypertension by 1.5-2 times and the effect is pronounced when alcohol exceeds 5 drinks per day. However, 1-2 drinks per day or 3-9 drinks per week has been shown to have beneficial effect on heart by decreasing the risk of cardiac diseases, including myocardial infarction.
Various studies results have shown improvement in cardiac function post alcohol abstinence in patients with alcoholic cardiomyopathy. For example, Nakanishi et al found significant improvements in 8 out of 11 patients in alcoholic cardiomyopathy who abstained from alcohol, while 3 patients who continued drinking worsened and 2 died of heart failure. Another 12 month observational study in 20 patients found lesser number of hospitalizations in 10 patients who abstained from alcohol.
A 1 and 4 year follow up study of 55 men with alcoholism also showed positive improvement for LV ejection fraction in patients who abstained from alcohol or who cut back to up to 60 g/day of alcohol. The 10 patients who continued to drink heavy amounts of alcohol died during the follow up.
Demakis et al found better prognosis in patients with alcoholic cardiomyopathy to be associated with 2 factors, which included abstinence from alcohol and shorter disease course before therapy initiation. They conducted a study in 57 patients of which 39 continued to drink and 18 abstained from alcohol. Of these 39 patients, only 4 improved, while from 18 patients who abstained, 11 improved.
Although, data exists that moderate amount of drinking in cardiac condition does not adversely affect the heart, major prospective studies show that abstinence from alcohol in the presence of cardiomyopathy helps in reversing the condition. Therefore, it is best to avoid alcohol when suffering from inflammatory cardiomyopathy for faster recovery and reversing symptoms and heart health. The mainstay of therapy is to treat the underlying cause of alcoholic cardiomyopathy and that is to completely abstain from alcohol.(1)
- Cardiomyopathy – Causes, Symptoms, Diagnosis, Treatment
- How is Apical Ballooning Syndrome or Stress Cardiomyopathy Different from a Heart Attack?
- Takotsubo Cardiomyopathy or Broken Heart Syndrome: Causes, Symptoms, Treatment
- Causes & Symptoms of Arrhythmogenic Right Ventricular Cardiomyopathy or ARVC
- Arrhythmogenic Right Ventricular Cardiomyopathy or ARVC: Treatment, Prognosis, Coping, Complications
- Restrictive Cardiomyopathy: Causes, Symptoms, Treatment
- Causes of Hypertrophic Cardiomyopathy & Its Treatment