Alcoholic cardiomyopathy medical therapy

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.

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.

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].

• 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.

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