Alcoholic cardiomyopathy: heart muscle weakened by heavy drinking

Cardiomyopathy is a general term for diseases of the heart muscle. The NHS describes it as a condition in which the walls of the heart chambers have become stretched, thickened or stiff, which affects the heart's ability to pump blood around the body. Alcoholic cardiomyopathy is the term used when heavy, long-term drinking is the main factor behind the heart muscle problem.

Alcohol is most often discussed in connection with dilated cardiomyopathy (DCM). The NHS says that in DCM the muscle walls of the heart become stretched and thin so they cannot squeeze properly to pump blood. The British Heart Foundation describes the left ventricle, the main pumping chamber, becoming enlarged with a thinner, weaker wall, giving the heart a rounder shape than its usual cone shape.

The pages read for this guide describe alcohol as one cause among several. In many people with DCM, the cause is unknown or runs in the family, and a doctor will usually want to rule out other contributors before attributing it to alcohol.

The British Heart Foundation says many people with DCM may not notice any symptoms at first, and that the most common symptoms are tiredness, chest pain, shortness of breath, swelling of the feet, ankles, stomach and lower back, and palpitations. Cardiomyopathy UK describes the same pattern, explaining that fluid can build up in the lungs and tissues because the heart is not pumping effectively.

The NHS says people with DCM are at greater risk of heart failure, where the heart fails to pump enough blood around the body at the right pressure, which typically causes shortness of breath, extreme tiredness and ankle swelling. There is also a risk of heart valve problems, an irregular heartbeat and blood clots. The British Heart Foundation lists the arrhythmias that DCM can cause as atrial fibrillation, ventricular tachycardias and heart block.

Persistent breathlessness, ankle swelling, unusual tiredness or palpitations are reasons to see a GP, particularly if you drink heavily. Chest pain and breathlessness together can be a medical emergency: the NHS says always to call 999 if you or someone else has chest pain and breathlessness like a heart attack. The NHS also advises calling 999 if you have a fast or irregular heartbeat with symptoms such as chest pain, shortness of breath, fainting or confusion.

Talking honestly with a GP about how much you drink is important, because it changes both the investigation and the treatment. The NHS says a GP or alcohol service will ask about your drinking and how it affects your life, and may offer a questionnaire and blood tests.

The NHS advises that men and women should not regularly drink more than 14 units of alcohol a week, and says there is no safe level. It also states that the previously held view that some alcohol was good for the heart has been revised, and that the evidence for a protective effect from moderate drinking is less strong than previously thought. Drinking more than 14 units a week over many years can increase the risk of stroke, heart disease, liver disease and some cancers.

For alcohol-use disorder, the NHS lists heart problems including cardiomyopathy and heart failure among longer-term risks, alongside liver damage, high blood pressure and stroke. It says stopping drinking is the best way to reduce the risk of serious health problems.

The pages read here do not give a number for how much drinking leads to cardiomyopathy, and it would not be right to quote one. How much and for how long varies between people, and a cardiologist will look at the whole picture.

The British Heart Foundation says that a doctor may suspect DCM if you have symptoms, a heart murmur, or a family member diagnosed with DCM, and will usually refer you to a cardiologist. The most common tests include an ECG, an exercise ECG, an echocardiogram (a scan of the heart using sound waves), an angiogram to look at the blood supply of the heart, and an MRI scan.

The NHS adds that heart rhythm monitors (24 or 48-hour ECG monitors) and a detailed family tree may be used, and that a genetic test may be advised if an inherited type is suspected. Because a family history and other causes need to be considered, doctors may ask about alcohol, medicines and recreational drug use as part of the assessment. The NHS also lists blood tests as part of an alcohol assessment.

The NHS says there is usually no cure for cardiomyopathy but treatments can be effective at controlling symptoms and preventing complications. Medicines may be needed to control blood pressure, correct an abnormal heart rhythm, remove excess fluid or prevent blood clots. For alcohol-related disease, the NHS lifestyle advice for cardiomyopathy specifically includes avoiding or reducing alcohol, eating healthily, gentle exercise, stopping smoking and managing other conditions.

The British Heart Foundation says some people with DCM who develop an arrhythmia need an implantable device, either an implantable cardioverter defibrillator (ICD), which can deliver an electrical shock to restore a normal rhythm, or a pacemaker. In rare cases where devices and medicines have not worked, a heart transplant may be considered, sometimes with a left ventricular assist device while waiting.

Treatment of the alcohol itself is part of the care. The NHS describes talking therapies such as cognitive behavioural therapy, medical help with withdrawal at home or in hospital, medicines to reduce cravings or prevent relapse, and support with other parts of life. It advises getting medical help before stopping if you get withdrawal symptoms, because stopping suddenly can be very dangerous for people dependent on alcohol.

The British Heart Foundation says many people with DCM feel fine or have few symptoms, and those with symptoms usually find them managed well with treatment and have a good quality of life, though some find symptoms get worse over time and should tell their healthcare professional. Most people can keep working, although not necessarily in manual jobs involving strenuous activity, and can enjoy most activities except some competitive sports and high-intensity exercise. Driving is usually possible, but not necessarily a lorry, bus or other commercial passenger vehicle.

Support is available for both parts of the problem. The NHS lists Alcoholics Anonymous and SMART Recovery for people stopping drinking and Al-Anon UK and Adfam for families, while Cardiomyopathy UK offers a nurse helpline and support groups for those living with cardiomyopathy.

On the NHS, heart tests and cardiology follow-up are arranged through the GP, and alcohol treatment can be accessed through the GP or a specialist alcohol service. Private cardiology can provide faster scans and consultations, and some private services provide alcohol detoxification, but the care of heart failure and alcohol dependence is often most effective when the two teams share information. Bring your medicines list and previous test results to any appointment.