Alcohol and heart failure...to heart transplant.

Earlier this week, one of my patients was a 29 year old male, being treated with heart failure. Even in his sleep, he struggles to breathe needing an oxygen.

Admitted a week ago with a complaint of increasing shortness of breath. His ECG shows a fast heart ryhthm (SVT). He reported to have been having shortness of breath for 6 weeks. History of daily consumption of 3-4 pints of alcohol, a marijuana user, with no history of any cardiac problem.

Heart Failure (HF) have a very high mortality rate around the world. In the US alone, it is estimated that 500,000 Americans are diagnosed with HF per year.(1) In my experience, severe complications have caused a lot of deaths. In our Heart Attack Centre, more often the cause of HF is from a heart attack, but not always.

ETHANOL

Alcohol consumption appears to play a role in the development of HF. It is suggested from recent studies that not only the quantity, but also the drinking patterns and genetic factors as predispositions to HF.(1a) Persistent high-dose consumption results in the deterioration of muscles and heart function resulting to a high mortality due to abnormal heart rhythms and severe heart failure.(2)

Drinkaware in its' website stated that heavy drinking weakens the heart muscle unabling the heart to pump blood efficiently.(3) A condition called Alcohol Cardiomyopathy, it is characterised by left ventricular (LV) dilatation, increased LV mass and reduced or normal LV thickness. (1a)

"Holiday heart Syndrome"

In 1978, this term was coined when patients reported feeling like they were having a heart attack, characterised by severe pain in the centre of the chest. It was found that this condition tend to increase around holiday times or on weekends, when people tend to drink more.

Diagnostics on admission and Management

1. Chest X-ray globular heart (enlarged)

2. Abdominal US hepatic congestion

3. Echocardiogram Ejection Fraction (EF) of 10%         

Ejection Fraction (EF) is the strength or ability of the Left Ventricle (LV) to pump-out blood out of the heart (LVEF). A good function or a preserved function usually have a percentage of 50 or above. Anything below 36% is poor or severe.

It has been said that with Alcohol Cardiomyopathy, patients more often when presenting themselves to the hospital, have already severe LV when having symptoms. Literature are saying that it takes 5-15 years of heavy consumption to cause this condition. Without symptoms, patients would have had developed heart failure but undiagnosed.

As my patient have only an EF of 10%, he is now being considered for a heart transplant. NB: Smokers are normally not a candidate for transplant or LV assist device ( LVAD).

In a better note, evidences have come out supporting major biological pathways by which moderate drinking, a consumption of 1-2 drinks per day or 3-9 drinks per wk, may lower the risk of HF. 

Pumping Marvellous is a heart failure charity in UK for patients. It can be found in facebook if needed.

*I am a nurse, not a doctor. Please do further reading of this condition.

Footnote:(1)https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2365733

(2)https://www.ncbi.nlm.nih.gov/pubmed/15490485

(3)www.drinkaware.co.uk/alcohol-facts/health-effects-of-alcohol/diseases/alcohol-and-heart-disease