Cardiomyopathy death (causes, prognosis)

With alcohol dependence, it is not only the liver and the cardiovascular system that suffer. Passion for alcoholic beverages leads to a huge number of problems in the work of the whole organism.

The health situation is especially bad for people who, along with drinking alcohol, also like to smoke. In this case, rarely does anyone manage to avoid the development of obstructive bronchitis.

In the presence of heart failure in the lungs, blood stasis occurs, which is greatly aggravated against the background of nicotine addiction, which causes respiratory spasm.

As a result, a person develops serious diseases of the respiratory system.

The digestive tract also undergoes bad changes. The effects of alcohol include pain near the right hypochondrium and discomfort in the epigastric zone.

In patients who are addicted to alcohol, liver enlargement and abdominal swelling due to poor venous outflow are often observed.

Alcohol has a detrimental effect on the excretory system. Because of it, the work of the kidneys is paralyzed, which is explained by the destruction of nephrons. In addition, busting with alcohol creates a serious burden on the kidneys. This makes them unusable even faster.

A neglected form of the disease without adequate therapy can cause such complications:

  • heart failure;
  • ventricular fibrillation;
  • thromboembolism;
  • instant cardiac death.

So that alcoholic cardiomyopathy does not cause death, at the first alarming signs it is necessary to undergo a comprehensive examination, after which the specialist will select the appropriate treatment. If you follow all the recommendations prescribed by your doctor, the risk of dangerous consequences is reduced.

Despite the fact that the prognosis for alcoholic cardiomyopathy is not very favorable, it is important to continue treatment. If irreversible processes are already running, it is unlikely to somehow affect it. But modern medicine is able to slow down the progression of morphological changes.

It is worth noting that with such a disease, a rather high percentage of patient survival is 81%. This is a really good indicator, especially when compared with dilated cardiomyopathy.

The prognosis sharply worsens if the patient continues to abuse alcohol. Against the background of alcohol intoxication, favorable conditions are created for the secondary development of the disease. In this case, death may occur after 4-5 years.

Experts predict a favorable prognosis only at the initial stage of the development of the disease, when the pathology has not yet caused serious harm to health. But at the same time you need to properly treat the disease.

Refusal of bad habits, proper nutrition, the presence in the diet of a sufficient amount of the necessary vitamins and minerals will help improve the condition, as well as minimize the occurrence of dangerous complications.

A similar pathological condition is necrosis of a certain section of the myocardium, which developed due to insufficient blood circulation. A similar complication is considered a dangerous manifestation of the development of cardiac ischemia. Hypertrophic cardiomyopathy is more often complicated by myocardial infarction, as the heart experiences acute nutrition and oxygen deficiency.

After a heart attack, on the myocardial tissues, the formation of connective tissue sites occurs, which leads to post-infarction cardiosclerosis, and in a neglected form, to death.

The developed heart attack makes itself felt with chest pain, sometimes radiating to the forearm of the left arm or lower jaw. The skin color of patients often takes on pale shades, they are tormented by shortness of breath and cold sweat, while the pulse is irregular and weak. If therapeutic intervention was timely, further myocardial necrotization can still be stopped.

A similar complication refers to fairly frequent pathological phenomena in cardiomyopathic forms. More often than others, cardiomyopathy is complicated by chronic heart failure, the signs of which are manifested in the form of tissue hypoxia and a decrease in myocardial ejection. Acute myocardial insufficiency is characterized by sudden development and is fraught with cardiogenic shock. If resuscitation measures are not taken, then heart failure quickly leads the patient to death, since hypoxia is detrimental to brain cells.

Myocardial insufficiency can be diastolic and systolic in nature. Diastolic insufficiency is based on insufficient blood supply to the ventricle at the time of its relaxation. Such a clinic is most characteristic of restrictive form cardiomyopathy. The systolic form of insufficiency is manifested by a weakening of myocardial contractions and a decrease in the ejection fraction. This is most characteristic of dilated cardiomyopathic form.

According to statistics, in almost all patients (90%), cardiomyopathy is complicated by various kinds of arrhythmias, caused by structural disorders of the tissues, which violate the prevalence of impulses in the heart tissues. The most dangerous is arrhythmia, which is localized in the ventricles, since it is characterized by large-scale violations of blood pumping and often leads to the death of the patient.

Any cardiomyopathy is fraught with thrombosis, which is associated with impaired blood flow between the chambers of the myocardium. Stagnations and vortices formed in the vessels contribute to the activation of the blood clotting system, as a result of which blood cells are glued together and a blood clot forms. If this thrombus leaves the myocardial cavity and is fixed in any of the vessels in the periphery, then thromboembolism is diagnosed. This condition disrupts the blood supply, provokes tissue death and can lead to the death of the patient.

The most dangerous thromboembolic forms are: ischemic stroke (death can occur when a blood clot enters the brain), pulmonary arterial thromboembolism, intestinal necrosis, thrombosis of the vascular system of the limbs.

A similar complication is a consequence of severe blood stagnation in a small circle of blood circulation. Usually a similar condition develops if cardiomyopathy is localized in the left half of the myocardium and is stagnant.

If the left half of the heart cannot cope with the incoming volume of blood, then its excess accumulates in the pulmonary vessels. This contributes to vascular expansion, as a result of which the blood plasma begins to leak out and accumulate in the alveoli.

The patient develops symptoms such as respiratory disorders, wet rales, pinkish sputum. If in this condition the patient does not receive urgent medical attention, then pulmonary edema in a short time leads to death due to a stop in blood circulation and breathing.

The prognosis of cardiomyopathy is often unfavorable, since the pathology is dangerous due to the progression of myocardial insufficiency, thromboembolic and arrhythmic complications (tachycardia, ventricular extrasystole, atrial fibrillation, etc.), myocardial conduction disorders, sudden coronary death. According to statistics, when diagnosing dilated cardiomyopathic form, only a third of patients live 5 years.

The worst risk is sudden death from heart failure. Other complications include:

  • disturbances in the rhythm and conduction of the heart;
  • blood clots in the heart;
  • ventricular tachycardia;
  • ischemic stroke.

Lack of treatment is a sure way to death. When ignoring the symptoms of the disease, the patient gradually forms blood clots in the heart. Over time, platelets become clogged by large arteries and provoke an ischemic stroke.

In the case of ventricular tachycardia, sudden ventricular fibrillation is possible. Without the lack of necessary medical care, a person risks a sudden cardiac arrest.

Without treatment, the heart will very quickly exhaust its resource in comparison with a healthy person. Within a short period of time, dystrophy of all vital organs occurs.

With cardiomyopathy, irreversible processes occur in the heart that change its structure. First of all, cardiomyocytes – cardiac cells – suffer. They undergo dystrophic and sclerotic changes, characterized by thickening of the walls of the myocardium, stretching of the ventricles and the formation of interventricular adhesions.

Each of these types of diseases has its own characteristics in the defeat of the heart muscle and symptoms. But all of them end with serious complications, which often result in a patient’s disability or death.

The syndrome is manifested by a violation of the pumping function of the heart muscle, which leads to poor blood supply to the whole body. The clinical picture depends on which of the ventricles is affected.

In the case of left-sided heart failure, a stagnant fluid process occurs in the pulmonary circulation. The main complication in this case is pulmonary edema.

Signs that cardiomyopathy led to left ventricular dysfunction are indicated by the following symptoms:
  • dyspnea;
  • cough (foamy or dry);
  • orthopnea;
  • cardiac asthma;
  • asthma attacks;
  • breathing problems (lack of air).
With right ventricular heart failure, an accumulation of excess fluid in the vessels of the pulmonary circulation is observed. Such a pathology is accompanied by the following symptoms:
  • swelling of the lower extremities;
  • fatigue;
  • dyspnea;
  • sputum cough;
  • accelerated heartbeat;
  • bouts of dizziness;
  • pain in the right hypochondrium (associated with liver edema);
  • dyspeptic manifestations;
  • renal dysfunction.

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Risk groups

Dilated cardiomyopathy is not included in the list of well-studied diseases. It is especially difficult to find out the causes of the onset of the disease. There are some assumptions, supported by scientific works, but the etiology itself is still being studied.

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Unfortunately, in thirty percent of cases, the disease is inherited. In general, every third patient with a similar disease has one of the closest relatives with the same diagnosis.

The toxic reason is much more prosaic – alcohol. Increased doses of ethanol provoke damage to contractile proteins, and violates the necessary level of metabolism. Moreover, not only alcohol is included in this group. Toxic lesions also include occupational diseases. People in contact with industrial dust, metals and harmful substances are also in the second risk group.

Elementary malnutrition, protein deficiency, and a lack of basic vitamins also provoke a risk of illness. However, such manifestations are possible only with a very long wrong lifestyle. This is very rare in medical cases.

For example, a person for about ten years had problems with proper nutrition, sleep patterns, as a result of which he had a malfunction, which entailed the occurrence of dilated cardiomyopathy, but such cases account for less than 5 percent of all cases. However, they usually come to the treatment of dilated cardiomyopathy, still having a concomitant bouquet of diverse, not only heart diseases.

Cardiac disease treatment

Alcoholic cardiomyopathy is a myocardial disease caused by excessive addiction to alcohol. The abuse of such products negatively affects the state of the heart tissue. Because of this, the work of the entire cardiovascular system is deteriorating. Against the background of this pathology, an increase in heart volume occurs and heart failure develops.

The only treatment for sudden death is emergency resuscitation. Resuscitation consists of several stages:

  1. Ensuring the free passage of air through the respiratory tract. For this, it is necessary to put the dying person on an elastic, rigid surface, tilt the head back, extend the lower jaw, open the mouth, free the oral cavity from existing foreign objects and take out the tongue.
  2. Perform artificial ventilation of the lungs by mouth-to-mouth method.
  3. Restoration of blood circulation. Before starting an indirect heart massage, you need to perform a “precardial beat”. To do this, sharply punch in the middle of the sternum, but not in the heart. Next, put your hands on the chest of a person and make chest impressions.

For an effective resuscitation process, the ratio of inhalation in the patient’s mouth of air and rhythmic pressure on the chest should be:

  • inspiration for 15 pressures, if one person resuscitates;
  • 1 breath and 5 pressures if two are resuscitated.

Immediately transport a person to a hospital to provide qualified assistance to professionals.

It is very important to consult a doctor at an early stage of the disease, when diagnosis is possible according to the primary symptoms. In this case, the prognosis will not immediately become favorable, but the health risk will be significantly reduced. In fact, the patient will increase his chances of fighting a disease that is difficult to treat with standard treatment.

The basic limitations before treatment for patients with dilated cardiomyopathy include:

  • Exclusion of physical activity;
  • a complete ban on the consumption of salt;
  • bed rest is desirable depending on the course of the disease.

Drug therapy is considered effective. According to statistics, for 80% of patients, drugs can be obtained that have a positive effect on the course of the disease.

The three above drugs are included in the group of inhibitors. With pronounced violations with the rhythm of the heart, special drugs are used adrenoblockers. The most popular remedy is bisoprolol. It is possible that the doctor will also prescribe medications aimed at reducing blood flow to the region of the right heart muscle.

Each disease is individual, therefore it is very important not to self-medicate in such a difficult situation. Most often, doctors prescribe a specific treatment for DCMP (dilated cardiomyopathy), based on the individual characteristics of the body. In most cases, blood thinners are additionally prescribed. In particular, simple aspirin or acekardol.

To get rid of the symptoms of shortness of breath in the uncomplicated course of the disease, doctors recommend special nitrates in the form of a spray. Often these patients help out the drug Nitromin, sold in the pharmacy in the form of an aerosol.

From this article you will learn: what is alcoholic cardiomyopathy, how much alcohol consumption increases the risk of its development. How is this disease diagnosed and treated.

Alcoholic cardiomyopathy is a disease in which prolonged abuse of alcohol leads to the expansion of the chambers of the heart and the appearance of signs of heart failure.

This disease is most common among men aged 35-50, but it can also develop in women.

Alcohol has a toxic effect on the heart muscle (myocardium), which reduces the effectiveness of heart contractions, which leads to the development of heart failure.

Alcoholic cardiomyopathy is classified as dilated cardiomyopathy, since in case of damage to the heart with ethyl alcohol and its metabolic products, expansion of its chambers develops (dilatation). Many doctors consider alcohol to be one of the most common causes of dilated cardiomyopathy in countries with severe alcohol abuse.

Heart failure developed as a result of alcoholic cardiomyopathy can be very pronounced, severely limiting a person’s functionality.

The prognosis for this disease depends on what stage of its development the patient stopped drinking.

In the later stages, heart damage becomes irreversible, in such cases only a heart transplant can help the patient.

The problem of alcoholic cardiomyopathy is dealt with by cardiologists, therapists, and narcologists.

The cause of alcoholic cardiomyopathy is alcohol abuse. Alcohol is the most commonly used toxic substance in humans. In small doses, it has certain beneficial properties for the cardiovascular system, however, exposure to large amounts of alcohol for a long time can cause damage to the myocardium.

Many scientific studies have been carried out in which scientists tried to determine what dose of alcohol causes cardiomyopathy. These studies each time showed different results, although many of them were quite similar.

Currently, most scientists agree that cardiomyopathy can be caused by daily consumption of at least 80 g of alcohol for 5 years. However, this figure cannot be considered any exact criterion and to think that if you drink alcohol in slightly smaller quantities, then there will be no heart problems.

When determining this dose, the gender and weight of the patient, the individual characteristics of the body, and the genetic predisposition to the development of cardiomyopathy were not taken into account.

Alcohol has a direct toxic effect on the heart. The following mechanisms of ethyl alcohol damage to the myocardium exist:

  1. Deterioration of protein synthesis in heart cells (cardiomyocytes).
  2. The accumulation of fatty acid esters inside cells.
  3. Free radical damage to cardiomyocytes.
  4. Inflammatory and immunological reactions.
  5. Violations of the membrane structure of cardiomyocytes.
  6. Spasm of the coronary arteries.
  7. Activation of the renin-angiotensin system (a hormonal system that regulates the amount of fluid in the body and the level of blood pressure).

Click on the photo to enlarge

Abuse of alcohol, in addition to cardiomyopathy, can cause other adverse consequences from the cardiovascular system. These include heart rhythm disturbances, high blood pressure, stroke, and sudden death.

Symptoms

Alcoholic cardiomyopathy in the early stages of its development in most patients does not cause any symptoms. As alcoholic cardiomyopathy progresses, the patient develops:

  • Shortness of breath, worse when lying down and during exercise.
  • Edema on the feet and legs, and in severe cases – on the hips and other parts of the body.
  • Chest discomfort.
  • Ascites is the accumulation of fluid in the abdominal cavity.
  • Reduced urine.
  • Loss of appetite.
  • Difficulty concentrating.
  • Fatigue, decreased exercise tolerance.
  • Weight gain.
  • Sputum cough.
  • A feeling of palpitations in the chest.
  • Heart rhythm disorders.
  • Dizziness.
  • Fainting (caused by heart rhythm disturbances, abnormal reactions of blood vessels during exercise).

However, it should be borne in mind that the appearance of these symptoms may indicate a severe and irreversible damage to the heart, which is practically untreatable. In the most severe cases of alcoholic cardiomyopathy, the patient’s dyspnea persists even at rest, so he cannot perform any actions accompanied by the slightest physical exertion.

Complications

The presence of alcoholic cardiomyopathy can cause death due to the following complications:

  • heart failure;
  • insufficiency of heart valves, which develops due to the expansion of its cavities;
  • heart rhythm disturbances, which are caused by changes in the structure of the heart and in the pressure inside its chambers;
  • sudden cardiac arrest;
  • the formation of blood clots in the cavity of the heart, which can break away from its walls and enter any part of the body, causing a stroke, heart attack or damage to other organs.

Diagnostics

To establish the diagnosis of alcoholic cardiomyopathy, the doctor collects patient complaints, examines him and prescribes additional examination methods.

The doctor finds out from the patient his medical history, and also asks whether he drinks alcohol and in what quantities. It is very important that the patient be honest with the doctor, not hiding problems with alcohol abuse, as this is necessary to establish the correct diagnosis and develop an appropriate treatment plan.

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Alcoholic cardiomyopathy is not diagnosed with laboratory tests. However, with their help, damage to other organs can be assessed, so the doctor can prescribe the following tests:

  • Blood chemistry.
  • Functional liver tests.
  • Determination of blood cholesterol.

If alcoholic cardiomyopathy is suspected, doctors may prescribe the following additional examinations:

  • Chest x-ray – allows you to evaluate the size and structure of the heart and lungs, to identify fluid in the pleural cavity.
  • Electrocardiography – records the electrical signals of the heart, allowing you to identify heart rhythm disturbances and problems with the left ventricle. Sometimes a daily ECG is called a Holter monitoring.
  • Echocardiography is one of the main methods for diagnosing alcoholic cardiomyopathy, using ultrasound waves to obtain a heart image. With the help of this examination, it is possible to identify expanded cavities of the heart, insufficiency of heart valves, blood clots in its chambers, and a decrease in contractility.
  • Stress test – a survey method that allows you to determine the patient’s exercise tolerance, with which you can assess the severity of alcoholic cardiomyopathy.
  • Computed or magnetic resonance imaging – using these methods, you can evaluate the size and functioning of the heart.
  • Cardiac catheterization is an invasive method of examination, during which a long and thin catheter is inserted into the chambers of the heart through vessels in the forearm, groin, or neck. During this test, the doctor can assess the patency of the coronary arteries, measure the pressure in the chambers of the heart and identify pathological changes in its structure. To do this, a contrast agent is introduced through the catheter, after which an x-ray examination is performed.

The reason for the development of alcoholic cardiomyopathy

The decisive role in the development of the disease is played by the amount of alcoholic beverages consumed. Epidemiological studies have convincingly proven that the possibility of death from coronary heart disease (CHD) and the dose of alcohol consumed are in a U-shape dependence on each other. The highest probability of death from alcoholic cardiomyopathy is in those people who do not drink alcohol and those who drink it excessively. Those who drink in moderation have a very low probability of death from coronary heart disease.

All patients are divided into non-drinkers, moderate drinkers (drink less than three drinks a day) and abusers (take three or more drinks a day). One drink is equal to 180 ml of beer, 30 ml of strong alcoholic drinks (vodka, cognac, tequila, whiskey, etc.) and 75 ml of dry wine. Studies have shown that alcohol abuse increases the likelihood of death from diseases of the cardiovascular system (CVD). Moderate doses of alcoholic beverages (3–9 alcohol drinks per week) reduce the risk of death from myocardial infarction and other coronary heart disease by 20–40%.

The likelihood of death as a result of CVD is reduced by 30-40% if you take one conditional portion of alcohol per day (equal to 50 ml of vodka). With an increase in this dose, its prophylactic effect disappears. But take into account the fact that the protective effect of alcohol with an existing CVD in humans is not proven. In young people with a low risk of cardiovascular disease, the negative impact of alcoholic beverages on their development prevails.

Reception of no more than 2 servings of alcohol per day is the prevention of stroke, atherosclerosis, ischemic heart disease. For men, a serving of 30 g of pure alcohol per day is safe. It corresponds to 660 g of beer, 240 g of dry wine, 75 g of strong drinks (cognac, vodka, whiskey, etc.). For women, a safe dose is equal to half of each of the above. There is an explanation for this: the female body is much more sensitive to the cardiotoxic effects of alcohol.

The WHO team of experts (“Prevention of chronic diseases, diets”) is of the opinion that the prophylactic dose of alcohol in relation to the development of IHD is 10-20 g of pure alcohol per day. It is best to consume red dry wines as this dose. This drink contains in large quantities substances that have an antioxidant effect and stop lipid peroxidation, which plays a significant role in the appearance of IHD.

The prophylactic effect of a small amount of alcoholic beverages in relation to the progression of coronary heart disease is associated with a decrease in platelet aggregation, an increase in the number of high density lipoproteins with a simultaneous decrease in the level of atherogenic low density lipoproteins, and an increase in blood fibrinolytic activity.

The likelihood of developing a disease such as alcoholic cardiomyopathy directly depends on the duration of the length of service and the number of servings taken. To date, there is no single point of view regarding the minimum daily dose of alcohol, which with prolonged daily use can provoke the development of alcoholic destruction of the myocardium. Also, the minimum duration of taking such a dose, necessary for the onset of the disease, is not completely determined.

The results of multicenter randomized observations conducted in the USA, Canada and European countries prove that the development of ischemic cardiomyopathy began with daily use of 80 ml of ethanol for 5 years or more, 125 ml of ethyl alcohol for 10 years and when taking 120 g of alcohol drinks for 20 years.

Different individuals have different sensitivity to alcohol-containing drinks, which can be explained by the genetically determined different activity of the enzymes that take part in the metabolism of alcohol and its products. For this reason, in different people, alcoholic cardiomyopathy begins under the influence of different daily servings and different durations of alcohol intake. It must be in the development of this disease the abuse of any alcohol is crucial.

With the increase in the number of deaths for no apparent reason, in recent decades there have been works aimed at a thorough study of heart defects associated with abnormal development of connective tissue. The term dysplasia (from the Greek “dis” – violation, “plasma” – form) means the abnormal development of tissue structures, organs or parts of the body.

Congenital dysplasia of the connective tissue is a disease that is inherited and is characterized by impaired tissue development, which underlies the structure of the heart. Failure occurs during fetal development and at an early stage after the birth of a child. They were conditionally divided into two groups.

The first are malformations that are quite well known and are manifested not only by a violation of the structure of the heart, but also of other organs and parts of the body. Symptoms and their manifestations are well known and studied (Marfan syndrome, Ehlers-Danlo, Holt-Omar).

The second – are called undifferentiated, they are manifested by violations of the structure of the heart, without distinct specific symptoms. This also includes malformations defined as “small heart abnormalities.”

The main mechanism of dysplasia of the tissue structures of the cardiovascular system is genetically determined abnormalities in the development of the components of the connective tissue that the valves consist of, parts of the conduction system of the heart and myocardium.

Young people who may be suspected of such disorders are distinguished by their lean physique, funnel chest, and scoliosis. Death occurs as a result of electrical instability of the heart.

There are three leading syndromes:

  1. Arrhythmic syndrome – a variety of rhythm and conduction disorders with the occurrence of fatal arrhythmias.
  2. Valvular syndrome is an abnormality in the development of the main valves of the heart with the expansion of the aorta, and the main pulmonary arteries, mitral valve prolapse.
  3. Vascular syndrome is a violation of the development of vessels of various diameters from the aorta to the irregular structure of small coronary arteries and veins. The changes relate to the diameter of the vessels.
  4. Abnormal chords – additional or false ligaments in the cavities of the heart, covering valve flaps.
  5. Valsava sinus aneurysms are the expansion of the aortic wall near the lunar valves. In the pathogenesis of this defect lies the influx of an additional volume of blood into the chambers of the heart, which leads to overload. More often boys are ill.

According to various publications, death with mitral valve prolapse is 1.9 cases of population.

In people suffering from a systematic increase in blood pressure, as a compensatory-adaptive reaction, hypertrophy develops (an increase in heart mass due to thickening of the muscle layer). This increases the risk of ventricular fibrillation and impaired blood circulation.

Arterial hypertension exacerbates the development of atherosclerosis in the lumen of coronary vessels. The frequency of hypertension in suddenly dead people reaches 41.2%.

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Svetlana Borszavich

General practitioner, cardiologist, with active work in therapy, gastroenterology, cardiology, rheumatology, immunology with allergology.
Fluent in general clinical methods for the diagnosis and treatment of heart disease, as well as electrocardiography, echocardiography, monitoring of cholera on an ECG and daily monitoring of blood pressure.
The treatment complex developed by the author significantly helps with cerebrovascular injuries and metabolic disorders in the brain and vascular diseases: hypertension and complications caused by diabetes.
The author is a member of the European Society of Therapists, a regular participant in scientific conferences and congresses in the field of cardiology and general medicine. She has repeatedly participated in a research program at a private university in Japan in the field of reconstructive medicine.

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