As pointed out before, the current accepted definition of ACM probably underestimates the number of women affected by the disease. Alcohol affects heart function and is dependent on the quantity of alcohol that the heart is exposed to. Women typically have a lower BMI than men, and therefore the same alcohol exposure can be achieved with lower alcohol intake. Demakis et al[70] in 1974 divided a cohort of 57 ACM patients according alcoholic cardiomyopathy is especially dangerous because to the evolution of their symptoms during follow-up. The sub-group of patients in whom symptoms improved was made up of a larger proportion of non-drinkers (73%), compared to 25% in the group who did not improve, or 17% in the group whose condition worsened. However, a possible confusion factor was identified because the group with clinical improvement also exhibited a shorter evolution of the symptoms and the disease.

History of hypertension was obtained from only 2 patients (2%) and 4 patients (4%) among those studied in South Africa and Haiti respectively. The mean age of the South African patients was 31.6 ± 6.6 years and 31.8 ± 8.1 years for the Haitians. From the foregoing, it is clear that peripartum cardiomyopathy is an important cause of morbidity and mortality among the indigenous populations of Kano and other parts of North-Central Nigeria, as well as in some parts of the developing world.

Box 2 NYHA classification of heart failure

Thus, although there is a certain degree of consensus regarding the recommendation of full alcohol withdrawal in ACM, it is yet to be resolved whether moderate alcohol consumption is sufficient to achieve an improvement in the prognosis of these patients. In this respect, a higher prevalence of excessive alcohol consumption has been reported among individuals diagnosed with DCM than in the general population[8]. In clinical and experimental studies, immunohistological evidence of inflammation was identified as an independent predictor of survival156,157. Thus, precise characterization and quantification of intramyocardial immune cell subtypes is needed to inform the decision to start immunosuppressive therapy with the goal of improving prognosis158,159. The use of immunohistochemistry has markedly increased the ability to detect cardiac inflammation from biopsy sections; monoclonal antibodies enable precise characterization, quantification and localization of different immune cell types and cell-adhesion molecules. Determining the cell composition of inflammatory foci affects the prognosis of DCM, and establishing the proportion and type of immune cells is crucial in deciding the optimal type of treatment.

Coinciding with the histological studies mentioned above, the majority of research on molecular mechanisms describes dysfunctions of intracellular organelles prompting alterations in the lipid-energetic metabolism and in calcium homeostasis, which are especially relevant for the contractile activity of myofibrils. In addition to the assessment of the status of the coronary arteries, cardiac catheterization may help obtain useful information regarding cardiac output, the degree of aortic or mitral valvular disease, and cardiac hemodynamics and filling pressures. Importantly however, remember that much of this information can be derived or inferred from the results of noninvasive testing. Results from resting and stress nuclear imaging techniques (eg, stress testing with thallium and sestamibi imaging, multiple gated acquisition [MUGA] scanning, positron emission tomography [PET scanning]) may be useful for evaluating cardiac size and function and for screening for coronary disease. Richardson et al showed an elevation of creatine kinase, LDH, malic dehydrogenase, and alpha-hydroxybutyric dehydrogenase levels in endomyocardial biopsy specimens taken from 38 patients with DC. We studied the clinical characteristics and outcomes of 94 consecutive patients with ACM and 188 with IDCM, evaluated over the period between 1993 and 2011.

The causes of dilated cardiomyopathy: a clinicopathologic review of 673 consecutive patients.

Mineralocorticoid antagonists and If inhibitors provide incremental benefit in survival or hospital admission when combined with ACE inhibitors and β-blockers162. Several lines of evidence indicate that DCM can result from an autoimmune disease according to the Rose-Witebsky criteria. Furthermore, autoimmune diseases such as systemic lupus erythematosus, systemic sclerosis and rheumatoid arthritis are rare causes of DCM, occurring in ~5–10% of cases95,96,97. Abnormal heart sounds, murmurs, ECG abnormalities, and enlarged heart on chest x-ray may lead to the diagnosis.

natural history and prognostic factors in alcoholic cardiomyopathy

Acute can be defined as large volume acute consumption of alcohol promotes myocardial inflammation leading to increased troponin concentration in serum, tachyarrhythmias including atrial fibrillation and rarely ventricular fibrillation. The mainstay of therapy for alcoholic cardiomyopathy (AC) is to treat the underlying cause, ie, to have the patient exercise complete and perpetual abstinence from all alcohol consumption. The efficacy of abstinence has been shown in persons with early disease (eg, prior to the onset of severe myocardial fibrosis) and in individuals with more advanced disease (see Prognosis). The pathologic and histologic findings of alcoholic cardiomyopathy (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. Histologically, light microscopy reveals interstitial fibrosis (a finding that has been shown to be prevented by zinc supplementation in the mouse model), myocyte necrosis with hypertrophy of other myocytes, and evidence of inflammation.