The alcoholic cardiomyopathy — damage of a cardiac muscle which is formed against the background of the excessive use of alcoholic drinks is shown by various morphological, functional, clinical violations. Patients complain of pain behind a breast, short wind, hypostases, a cold snap of the lower extremities. Development of heart failure, deadly violations of a rhythm, a thrombembolia is possible. The alcoholic cardiomyopathy is diagnosed by means of the ECG, Ekho-KG, a X-ray analysis. Treatment is conservative, at irreversible changes of body heart transplantation is shown.
Alcoholic damage of a myocardium — the frequent reason of a cardiomyopathy. Occurrence is defined by prevalence of alcoholism in population. The disease develops at the people of middle age who are systematically taking alcohol throughout a long time more often. Among patients prevalence of males is noted. The probability of pathology increases during the smoking, stresses, existence of other factors promoting developing of heart troubles and vessels. Not less than 30% of cases of a dilatatsionny cardiomyopathy are the share of an alcoholic cardiomyopathy.
Reasons of an alcoholic cardiomyopathy
The main etiofaktor is the long use of a large number of alcoholic drinks, usually – in an equivalent of 100 ml of pure ethanol every day within 10-20 years (on statistical data, in Russia average consumption of alcohol in a year on one person makes from 11 to 14 liters or about 35-40 ml a day). The disease is diagnosed for 50% of chronic alcoholics. Refer hereditary predisposition, immune violations, irrational food, chronic stresses, overfatigue, smoking to the factors promoting emergence of a cardiomyopathy.
The negative impact on a myocardium is exerted, first of all, by toxic products of metabolism of alcohol, mainly – ethyl aldehyde. This substance is formed by cells of a liver after splitting of ethanol and then comes to a blood-groove. Reaching heart, it causes structural and functional violations: negatively influences reproduction of sokratitelny proteins of a cardiac muscle, reduces its force, breaks metabolism in kardiomiotsit (transport of lipids, potassium, calcium).
Disorders of metabolism and violation of electrolytic balance become the reason of arrhythmias, decrease in functional activity of heart, development of fibrous changes. There are data demonstrating that ethyl aldehyde influences synthesis of some connections, in particular – stimulates production of the pro-inflammatory tsitokin and proteins capable to provoke the autoimmune answer. Besides, at high content in blood the ethanol and various substances added to alcoholic beverages — impurity of metals (for example, cobalt), dyes, preservatives can directly have direct toxic effect on heart.
Systematization of types of an alcoholic cardiomyopathy is carried out taking into account features of clinical symptomatology, degree of expressiveness of these or those manifestations. Division is rather conditional as symptoms of a disease differ in variability — the symptoms corresponding to different types of a disease can come to light at one patient. Allocate four forms of pathology:
- Classical. In a clinical picture heart failure dominates. At the termination of alcohol intake positive clinical and echocardiographic dynamics is noted, the abstention period lasts longer – the condition of the patient becomes better. Renewal of reception leads to bystry deterioration in a state, repeated emergence and aggravation of symptoms.
- Pseudo-ischemic. The main manifestation — the pricking or aching pains in kardialny area in the presence of changes of the ECG peculiar to coronary heart disease. Kardialgiya arise after alcohol intake, are not connected with physical activities, are not stopped by nitroglycerine. Expressiveness of symptomatology gradually progresses.
- Arhythmic. In clinic violations of a warm rhythm prevail. Vibrating arrhythmia is found in 20% of patients, premature ventricular contraction, tachycardia, tremblings or fibrillation of auricles comes to light less often. Feature of arrhythmias of an alcoholic etiology is their emergence after massive reception of etanolsoderzhashchy drinks. Violations of a rhythm can be the first and quite often only symptom of a cardiomyopathy.
- Mixed. Combines manifestations of all previous options of damage of a myocardium. It is considered the most adverse as symptoms mutually aggravate each other that considerably worsens the forecast of a disease. At 30-40% of patients the signs testifying to predisposition to heavy ventricular violations of a rhythm, sudden warm death decide on this type of a cardiomyopathy on the ECG.
Symptoms of an alcoholic cardiomyopathy
The beginning of a disease is characterized by the nonspecific manifestations arising owing to functional violations of activity of various bodies and systems in 4-5 years after the systematic use of large volumes of alcoholic drinks. Patients complain of bystry fatigue after insignificant physical activities, weakness, drowsiness, the increased sweating. At intensive loading long thorax pains, in a nape are possible. Violations of a rhythm are presented by premature ventricular contraction, tachycardia, feeling of sinking heart. Vegetative frustration include feeling of heat, trembling of hands, reddening of face skin, excitement or block. Usually symptoms appear next day after an alcoholic excess. During abstention from alcohol intensity of manifestations decreases. The symptomatology can remain up to 10 years.
At continuation of systematic consumption of etanolsoderzhashchy drinks the myocardium hypertrophy which is quickly replaced by dilatation develops. Cameras of heart extend, their sokratitelny ability decreases that becomes the reason of heart failure, stagnation of blood in a small and big circle of blood circulation. Constant short wind is observed, suffocation attacks at night, hypostases of the lower extremities, cough are added to a clinical picture of a disease (dry or with a small amount of a light phlegm). Cyanosis, a cold snap of hands, legs can come to light.
In the absence of treatment against the background of a cardiomyopathy irreversible structural changes of internals develop. Because of disorders of circulation work of kidneys is broken, in an organism the toxic products of exchange which are negatively influencing activity of TsNS and internals collect. Defeat of nervous system leads to encephalopathy, the shown decrease in cognitive functions, unmotivated aggression, embitternment, uncertain gait, sleep disorders. At a terminal stage gross violations from nervous system are observed, the progressing of a heart, renal and liver failure leading to death of the patient.
At alcoholic damage of a myocardium the high risk of emergence of complications is noted, including – zhizneugrozhayushchy. The most widespread consequence is critical violation of a rhythm — fibrillation of ventricles which is characterized by inefficient reductions and without medical care leads to cardiac arrest. Against the background of functional insufficiency of a cardiac muscle the movement of blood in cameras is slowed down, its rheological properties are broken, the probability of tromboembolichesky complications with development of a stroke, myocardial infarction, sharp renal failure, a necrosis of various departments of a GIT increases.
Diagnosis of this pathology is performed by the therapist or the cardiologist. As patients often suppress the fact of abuse of alcoholic drinks, at suspicion on a cardiomyopathy of alcoholic genesis interview relatives of patients, at identification of the corresponding etiology appoint consultation of the narcologist for the choice of optimum tactics of treatment of dependence. The list of diagnostic actions includes:
- Objective inspection. The uneasy or slowed-down behavior, cyanosis of finger-tips, a nose, ears, the top part of a thorax can be found. At a palpation the increased perspiration, hypostases and a cold snap of extremities, swelling and a pulsation of vessels of a neck is noted. Increase in the sizes of heart at percussion testifies to a hypertrophy or dilatation of its cameras. The pathological noise characteristic of structural changes of a myocardium, valves are defined by Auskultativno.
- Electrocardiography. Is a basic tool method of a research, allows to reveal violations of a rhythm, to obtain data on organic damage of a myocardium, to assume its toxic etiology. The ECG can be supplemented with daily monitoring on Holtera. In the absence of contraindications appoint a veloergometriya.
- Echocardiography. It is applied to assessment of a condition of coronary arteries and the valvate device, detection of a hypertrophy and dilatation of a myocardium, reduction of speed of a blood-groove, determination of pressure in cameras. It is carried out for differential diagnostics of a cardiomyopathy and perikardit.
- Thorax X-ray analysis. Signs of increase in cameras of heart are visualized, dilatation of the ascending aorta is more rare. The technique is used for specification of a condition of other large vessels, identification of pathological educations. On the basis of pictures it is possible to suspect defects of valves.
Differential diagnostics of a cardiomyopathy of an alcoholic etiology is carried out with diseases with a similar clinical picture: stenocardia, coronary heart disease, a myocardial infarction, stratified aorta aneurism, pleurisy, pneumonia. Other types of cardiomyopathies are excluded: restrictive, hypertrophic, aritmogenny dysplasia of the right ventricle.
Treatment of an alcoholic cardiomyopathy
Complex therapy of a disease includes the termination of the use of etanolsoderzhashchy drinks, fight against heart failure, correction of disorders of metabolism, restoration of functions of other bodies. The positive effect from course treatment is possible at an early stage of a disease in the absence of irreversible violations. At late stages continuous reception of medicines is necessary. Allocate the following directions of treatment of a cardiomyopathy:
- Change of a way of life. Provides full refusal of alcohol, a smoking exception. The diet with a large amount of protein, restriction of salt and fats is appointed. Preference is given to the steamed, stewed or boiled dishes, food is carried out by small portions of 4-6 times a day. Daily consumption of liquid makes no more than 1,5 liters. Sufficient physical activities, a healthy sleep, decrease in level of a stress are important.
- Medicamentous therapy. Is a basis of treatment of a disease, provides use of several groups of medicines which are appointed individually taking into account symptomatology. For normalization of arterial pressure antigipertenzivny means, are applied to prevention of violations of a rhythm — an antiaritmika, to elimination of hypostases – diuretic, to decrease in level of cholesterol of blood — statins. At a heavy current the plan of treatment is supplemented with warm glycosides for knocking over of attacks of takhiaritmiya, antiagregant and anticoagulants for prevention of tromboembolichesky complications.
- Surgical intervention. At inefficiency of conservative therapy, bystry progressing of an alcoholic cardiomyopathy with high risk of development of dangerous complications the question of transplantation of heart is considered. The method provides high 10-year survival (about 75%), is applied at satisfactory condition of an organism, lack of gross mental and intellectual violations. Shortcomings of a technique are injury, high cost, deficiency of donor organs.
Forecast and prevention
At early stages of a disease on condition of full refusal of alcohol and a timely initiation of treatment the forecast favorable. At development of irreversible changes of a cardiac muscle essential reduction of life expectancy is noted. Prevention of a cardiomyopathy is not only a medical, but also social task, includes measures for fight against alcoholism: informing the population on the basic principles of a healthy lifestyle, restriction of advertizing of alcoholic beverages and their distribution among youth at the legislative level. Preventive measures also assume bringing to the public of data on consequences of long alcoholic intoxication, its influence on heart, other bodies and systems.