2023 ICD-10-CM Diagnosis Code I42 6: Alcoholic cardiomyopathy

The American Heart Association (AHA), however, has found that regular use of alcoholic beverages has not been definitively shown to reduce the risk of heart disease. Instead, a proper diet and regular exercise are better ways to maintain good heart health. The AHA also reports that any potential benefits that red wine may create can be obtained from other non-alcoholic sources, such as grape juice. The pathologic and histologic findings of https://ecosoberhouse.com/article/how-to-recognize-the-warning-signs-and-symptoms/ (AC) are essentially indistinguishable from those of other forms of dilated cardiomyopathy (DC). Findings from gross examination include an enlarged heart with 4-chamber dilatation and overall increased cardiac mass.

After a low dose CT scanning for location (120 kV and 140 mA), 11C-acetate with a dose of 740 MBq was injected intravenously, followed by a 40-min dynamic PET scan. The FDA is continuing to investigate and gather more information in an effort to identify whether there is a specific dietary link to development of DCM and will provide updates to the public as information develops. The FDA looks to industry organizations and pet food manufacturers to contribute alcoholic cardiomyopathy to the FDA’s investigation while continuing their own investigations to help shed light on potential issues with formulas or ingredients. Another puzzling aspect of the recent spike in DCM cases is that they have occurred just in the last few years. The FDA is working with the pet food industry to better understand whether changes in ingredients, ingredient sourcing, processing or formulation may have contributed to the development of DCM.

Patient History

A healthcare provider can also connect you with available resources and refer you to other specialists and experts who can help you reduce or stop your alcohol intake. The available research shows that if you limit your alcohol intake to a certain amount, you’re less likely to develop alcohol-related health problems, including alcohol-induced cardiomyopathy. Pharmacologic therapy should include goal-directed heart failure therapy as used in idiopathic dilated cardiomyopathy with reduced ejection fraction. This includes a combination of beta-blockers, an angiotensin-converting enzyme inhibitor, diuretics, aldosterone receptor antagonist and angiotensin blocker-neprilysin inhibitor (if LVEF is less than or equal to 40%). The use of carvedilol, trimetazidine with other conventional heart failure drugs have been proven to be beneficial in some studies. On physical examination, patients present with non-specific signs of congestive heart failure such as anorexia, generalized cachexia, muscular atrophy, weakness, peripheral edema, third spacing, hepatomegaly, and jugular venous distention.

Ask any patient presenting with new heart failure of unclear etiology about their alcohol history, with attention to daily, maximal, and lifetime intake and the duration of that intake. To identify the causative agent of AC, investigators administered ethanol to rats pretreated with inhibitors of ethanol metabolism. Use of ethanol alone or ethanol with an alcohol dehydrogenase inhibitor resulted in a 25% decrease in protein synthesis.

Cardiac Effects of Alcohol

Current research into the pathogenesis of this condition has refined our understanding of the direct and indirect toxic effects of alcohol on the heart. Epidemiological studies attribute a significant role to alcohol abuse as a cardiovascular risk factor while clinical reports have established that alcoholic cardiomyopathy results in increased morbidity and mortality. Initially a clinically silent condition that can be detected by echocardiographic and electrocardiographic abnormalities, alcoholic cardiomyopathy slowly progresses to overt low-output heart failure. Abstinence is beneficial and can determine the reversal of cardiac impairment with a positive impact on prognosis.

Many people know that long-term alcohol abuse can affect the liver and cause it to fail. However, other organs, including the heart, are also at risk when alcohol abuse is heavy and chronic. Alcohol consumption can lead to a heart condition called alcoholic cardiomyopathy, which may progress to congestive heart failure if left untreated. Hypertension due to alcohol may be a confounding comorbidity in that it may contribute to LV dysfunction; therefore, LV dysfunction due to hypertension must be differentiated from pure AC. During the first half of the 20th century, the concept of beriberi heart disease (ie, thiamine deficiency) was present throughout the medical literature, and the idea that alcohol had any direct effect on the myocardium was doubted.

Table 1: Mean Age and Weight – DCM Cases in Dogs Reported to FDA-CVM

That’s because vitamin and mineral deficiencies are more common in individuals who are chronic heavy drinkers. Consider a heart-healthy diet, such as the Mediterranean diet or the DASH diet. As you reduce your alcohol intake, your provider will also treat your symptoms.

Alcoholic cardiomyopathy accounts for about one-third of all the nonischemic, dilated cardiomyopathies [29]. When the cardiovascular system is exposed to ethanol, acute and chronic changes occur in both systolic and diastolic functioning, with the most significant being a depression in contractility. If alcohol consumption continues, 40–50% of patients will die within 3–6 years [30], because continued consumption leads to further myocardial damage and fibrosis.

International Patients

In patients with dilated cardiomyopathy, if additional questions remain after a history is obtained and noninvasive testing is performed, cardiac catheterization may be used to help exclude other etiologies of heart failure. Palpitations, dizziness, and syncope are common complaints and are frequently caused by arrhythmias (eg, atrial fibrillation, flutter) and premature contractions. In the setting of acute alcohol use or intoxication, this is called holiday heart syndrome, because the incidence is increased following weekends and during holiday seasons.

• It’s very important to stick with the treatment plan and to stop drinking alcohol during recovery.
• Investigators found increased levels of catecholamines, altered myocardial refractory periods and conduction times.
• Individuals with this condition who don’t stop drinking heavily are at the greatest risk.
• This usually involves limiting your sodium (salt) and cholesterol intake and ensuring you are getting a diet that provides all essential nutrients.

What’s more, alcohol can contribute to obesity and the long list of health problems that can go along with it. Alcohol is a source of excess calories and a cause of weight gain that can be harmful in the long term. Electrolyte abnormalities, including hypokalemia, hypomagnesemia, and hypophosphatemia, should be corrected promptly because of the risk of arrhythmia and sudden death.

Enhancing Healthcare Team Outcomes

The ESC brings together health care professionals from more than 150 countries, working to advance cardiovascular medicine and help people to live longer, healthier lives. Veterinary cardiologist Dr. Joshua Stern from the University of California at Davis has been studying the rise in cases of DCM in Golden Retrievers, including a potential dietary link. Pet owners who suspect their Golden Retrievers may be affected may wish to consult their veterinarian to discuss checking taurine levels or conducting an echocardiogram.

Alcohol consumption is the third leading lifestyle-related cause of death for people in the US, behind tobacco and improper diet/lack of physical activity, and is responsible for 3.8% of all deaths globally [1,2,3]. Alcoholic cardiomyopathy accounts for up to 40% of patients with non-ischemic dilated cardiomyopathy [4]. Without complete abstinence, the 4-year mortality rate for alcohol-induced dilated cardiomyopathy approaches 50% [5]. Although moderate alcohol consumption may not be harmful to the cardiovascular system, excessive intake of alcohol can damage the myocardium via stimulating the apoptosis of cardiomyocytes and inhibiting energy metabolism [6,7,8,9]. Initially, alcohol consumption leads to asymptomatic left ventricular (LV) dysfunction, and can result in symptoms of heart failure if continues. A congestive alcoholic cardiomyopathy is characteristic of prolonged heavy alcohol abuse (Preedy et al., 1993).

FDA veterinarians have been working with the veterinary community to exchange information about existing cases and the type of clinical information that is most helpful to the investigation. We are also consulting with a cadre of board-certified veterinary cardiologists and nutritionists to learn more about the presentation of these cases and how they respond to treatment. In addition, Vet-LIRN has contracted with a network lab to collect blood (whole blood and plasma), urine, feces, and DNA from dogs without a known breed predisposition to DCM (as a point of comparison) to send to Vet-LIRN for testing.