Alcoholic cardiomyopathy - Causes, Symptoms and Treatment .MF .
Symptoms Diagnosis Treatment
Complications and prognosis
From time immemorial, man has resorted to the help of alcohol to relieve emotional stress, to relax, to forget the current difficulties or noting some joyful event.Indeed, sometimes a drink - other alcoholic beverages can not hurt.But, unfortunately, it often happens that the first person drinks alcohol on occasion, a few times a month, and then more and more often, a couple of times a week, then daily.Subsequently, the alcohol does not bring any of euphoria and relaxation, but only exacerbates health problems.We will not dwell on the problem of pathological craving for alcohol, and a look at some aspects of the negative influence of alcoholic beverages on the human body.Let's look at the bottom of the glass, in which a man drowning his sorrows and joys?
ethanol contained in any alcoholic drink, a few minutes later absorbed into the blood and processed by enzymes in the body in a very toxic substance - acetaldehyde.This s
Meanwhile, scientists proved that a daily intake of one to three doses of alcohol (10 - 30 grams of pure ethanol) may reduce the risk of cardio - vascular disease and cardiac death.This phenomenon is called the "French paradox", as adopted everyday use red and dry wines in France.Safe is considered to be the daily consumption of dry wine at a dose not exceeding 240 ml, cognac and vodka - 75 ml.For women, these dosages should be reduced by half due to higher alcohol toxicity in the female body.
In Russia, different statistics, related primarily to the peculiarities of our mentality.The Russian people, as a rule, does not know the sense of proportion in the use of alcoholic beverages, the more often resorts to the help of spirits (vodka, brandy, moonshine) in doses exceeding the harmless.In addition, in recent years become increasingly popular frequent consumption of beer in a large number of men, women, and even teenagers.People mistakenly believe that if the beer is too strong liquor, and the harm it can bring.However, beer contains, in addition to ethanol, a variety of other hazardous substances, such as cobalt, which was added to increase foaming.cobalt compounds have a direct damaging effect on the myocardium.
The systematic use of alcohol most affected the brain, heart and liver.With long-term heart disease products of ethanol metabolism in the body develops alcoholic cardiomyopathy.
disease Alcoholic cardiomyopathy - a disease that develops with regular use of alcohol and due to the destruction of cell structures and metabolic disorders in cardiac muscle cells and their subsequent restructuring, and characterized by enlargement of the heart chambers and manifested symptoms of cardiac arrhythmias and heartfailure.Observed in 50% of patients in the daily drinkers of more than 150 ml in terms of pure ethanol, frequently in males 45 - 50 years.
Signs of myocardial damage more likely to develop in terms of not less than ten years of systematic abuse of alcohol, but may develop already after 4 - 5 years.Most heart failure develops faster than cirrhosis of the liver, and is accompanied by damage to the nervous system with alcoholic psychoses, "white" fever, etc.
The development of cardiomyopathy may affect the patient and their existing risk factors such as obesity, hypertension, coronary heart disease, diabetes, family history of sudden cardiac death.
Symptoms of alcoholic cardiomyopathy
first symptoms may appear within 4 - 5 years of systematic abuse of alcohol.Clinical manifestations can vary depending on the stage of the process:
1. On stage of functional disorders, which can last more than a decade, patients report such symptoms:
- autonomic disorders of the vascular and nervous system - sweating, burning sensation, hand tremors, cold extremities of the skin, a persistent redness of the skin, emotional agitation or retardation, sleep disturbances,
- by heart - feeling short of breath, persistent pain in the heart, not associated with physical activity, occipital headaches, nausea andvomiting associated with high blood pressure,
- symptoms of transient or persistent arrhythmias - sense of fading, "turning" of the heart, a sense of heart failure followed by palpitations are typical for ventricular arrhythmia, sudden acceleration of cardiac rhythm with a frequency of more than 120 per minute canbe symptoms of atrial fibrillation or ventricular tachycardia.Arrhythmias can occur suddenly and deliver the expressed discomfort (paroxysmal) or exist permanently - permanent form.
2. Persistent hypertrophy (increase in weight) or dilation (expansion chambers) heart.It shows signs of stagnation of blood in the heart and in the internal organs, develop severe heart failure.The development of disease is due to more and arrhythmias, which by this time taking a firm character and lead to myocardial wear.Characteristic symptoms:
- constant shortness of breath at the slightest of physical activity and at rest,
- swelling of the face, legs and feet,
- a bluish staining the fingertips, nose, ears, extended capillary network on the nose (red streaks and "dove" nose)
- urination disorders in connection with blood circulation in the kidneys,
- increase in the abdomen due to stagnation of blood and swelling of the liver parenchyma,
- neurological symptoms of the - of encephalopathy and venous stasis in the brain - aggression, irritability, anger, trembling of the hands,staggering gait, insomnia.
3. Severe dystrophy infarction and all internal organs .Changes in the internal organs caused not only by the inability of the heart to pump blood through the body, causing circulatory disorders at the level of the smallest vessels in each organ and oxygen starvation of cells, but also the direct toxic effects of ethanol on cells.There is the death of liver cells, brain, kidneys, and pancreas.Clinically it is manifested severe exhaustion of the patient, the skin swelling of the hands, feet, face, swelling of the lining of the body cavities (ascites, hydrothorax).The patient concerned severe shortness of breath at rest, haunting suffocating cough, frequent episodes of cardiac asthma with the inability to breathe in the supine position, low blood pressure.Chronic poisoning of the body by alcohol and exhaustion of the heart muscle results in significant impairment of blood circulation, and to the patient's death.
Diagnostics alcoholic cardiomyopathy
For each patient with the disease is obligatory consultation psychiatrist - narcologist for the optimal treatment of alcohol dependence.patients often hide their addiction, so for suspected alcohol heart damage doctor should interrogate relatives of the patient.
Suspected namely alcoholic heart disorders in clinical, confirmed by echocardiography, may be at negative rheumatic samples, normal levels of thyroid hormones and the adrenal glands, that is, to the exclusion of hypertrophic cardiomyopathy caused by heart defects, dyshormonal, postmiokarditicheskoy and other cardiomyopathies, especially if patients do notIt denied the fact of the constant use of alcohol.
To clarify the extent of cardiac functions, the following methods are used: - Echocardiography -
used to determine the heart size, the volume serdenchyh cameras, myocardial thickness.When alcohol is more common lesion dilatation cameras increase in their volume than hypertrophy (thickening) of the myocardium.Characteristically reduced ejection fraction (less than 55%) and an overall reduction of myocardial contractility.
- ECG, daily monitoring of Holter, ECG exercise stress ECG after transesophageal electrical stimulation of the heart - are used to clarify the nature of cardiac arrhythmias.
- pi x-ray of the chest cavity can be observed a distinct increase in the shadow of the heart, as well as signs of venous congestion in the lungs (increased pulmonary pattern).
- in the general analysis of blood may be small or marked reduction of hemoglobin (anemia), in the general analysis of urine protein may cause bilirubin due to kidney damage and liver alcohol and venous stasis in them.
- in the biochemical analysis of blood observed decrease in total protein, increased bilirubin, increased liver enzymes (ALT, AST) and renal indices (urea, creatinine), increased alkaline phosphatase.Specific markers of alcoholism does not exist.
- ultrasound of the liver, pancreas, kidneys detect violations of varying degrees - from mild diffuse changes to cirrhosis of the liver and pancreatic necrosis ( "withering away" of the pancreas)
- ultrasound in combination with hormonal studies of blood thyroid and adrenal glands may reveal violations entailingdyshormonal development of cardiomyopathy, ie help in the differential diagnosis.
Treatment of alcoholic cardiomyopathy
basic principle of treatment of a disease - complete abstinence from alcohol.It is proved that the cessation of drinking stops the progression of cardiac dysfunction, cirrhosis of the liver and lesions of the pancreas.However, regression of symptoms is observed only in the early stages of cardiomyopathy.Naturally, in the third stage of heart function has been violated to such an extent that the support it is possible to work only with the help of long-term and continuous administration of drugs.
In the first stage of the disease is enough the following groups of products:
- vitamins, minerals and cardioprotectors improve metabolism in the heart muscle cells, normalize heart rhythm, tachycardia eliminating unpleasant symptoms.These include vitamins A, E, C, B vitamins (cyanocobalamin, pyridoxine, thiamine, riboflavin), niacin and folic acid;potassium and magnesium products (Pananginum, asparkam, magnerot);mexidol aktovegin courses.
- to normalize blood pressure and prevent arrhythmias apply - antihypertensives (enalapril, prestarium, noliprel, etc.), and antiarrhythmics (Cordarone, propranolol, propranolol, etc.).
In the second and third stages of further appointed:
- diuretics - diuretics (indapamide, Lasix, veroshpiron et al.),
- cardiac glycosides (digoxin, Korglikon) are shown for continuous reception at a constant form of tachyarrhythmias, as well as intravenously for reliefparoxysms of arrhythmia in a hospital or emergency room.Exceeding the dose prescribed by the doctor is not allowed in connection with the development of cardiotoxic effects (glycoside intoxication).
addition, with concomitant coronary heart disease, obesity, and violation of cholesterol metabolism are shown:
- statins - drugs that normalize blood cholesterol - atorvastatin, rosuvastatin, and others
- nitrate - nitroglycerin under the tongue, nitrosorbid, pektrol, kardiket.for long-term use
- antiplatelet agents and anticoagulants (aspirin, tromboAss, atsekardol, aspikor, warfarin, Plavix, etc.) prevent the formation of blood clots and the development of thromboembolic complications.
Lifestyle in alcoholic cardiomyopathy
patient should carry out the following recommendations:
1. Proper varied diet:
- complete abstinence from alcohol !, restricting smoking,
- recommended adequate intake of dietary protein (90 - 100 gramsday 50/50 animal and plant origin), fat (70 - 80 grams per day) and carbohydrate (300 grams per day)
- 4 - 6 - meals a day in small portions,
- favored dishes cooked in the steam, stewed, boiled, eliminated fried foods,
- excludes fatty, salty, spicy dishes,
- limited eggs, lard, margarine, fatty meats and poultry, bakery products, chocolate, coffee,
- limited fluid intake is no more than 1.5liters per day, salt no more than 3 grams per day,
- welcome fresh fruit, berries and vegetables, fresh juices, fruit drinks, jelly, fruit, lean meats, fish and poultry, sea fish (salmon, mackerel), wholemealgrinding, cereals, dairy products, potatoes.
2. Sufficient physical activity - walking, fishing, mushroom picking, berry
3. Adequate sleep - at least 8 hours of sleep a night, rest during the day
4. Limitation stressful situations, with the exception of heavyphysical labor
5. Course or continuous reception drugs prescribed by a doctor for
Complications of alcoholic cardiomyopathy
patients with alcohol-induced infarction may develop:
- life-threatening arrhythmia - ventricular fibrillation, in the absence of medical care leading to cardiac arrest.Clinically manifested by a sudden deterioration of health, very frequent pulse (more than 200 per minute), after a few seconds or minutes gives way to lack of a respiratory arrest and cardiac activity.Prevention is a timely reference to the doctor when a disruption in the heart and antiarrhythmic drugs prescribed by your doctor.
- thromboembolic complications often develop with cardiomyopathy due to the formation of blood clots in the slowly advancing on the blood chambers of the heart.The thrombus may "break" of the heart wall, and blood flow to treat a brain artery, renal, coronary artery, mesenteric, femoral artery.In such cases develop ischemic stroke, acute renal failure, myocardial infarction, bowel necrosis, lower extremity arterial thrombosis, respectively.These diseases can result in lethal or lead to loss of health and disability to the patient.Prevention - receiving anticoagulants and antiplatelet agents for the purpose of the attending physician.
Weather Forecast at full refusal of alcohol, early detection of the disease (in the first - the second stage) and time begun treatment favorable.
If the patient continues to drink alcohol, even at the third stage of the disease, it is currently significantly shortens life expectancy.Mortality during the first 5 - 6 years from the onset of clinical manifestations of 40 - 50%.12 - 22% of alcoholics are dying because of cardiomyopathy.In cardiomyopathy 35% leads to sudden cardiac death.
Temporary disability sick leave for employees for a period determined by the citizens, which requires examination and treatment in hospital (10 - 14 days), in complicated forms - up to three months.If after this time, Labor dubious prognosis, the patient is sent to MSEK for the determination of disability.If the patient develops II A and higher stage of chronic heart failure, he I or II disability group can be assigned.For working people with III (working) conditions of work group should not be difficult - do heavy physical work, at night, two or more shifts in a row, leaving on business trips, the work involves finding the mark (painters, window cleaners), long walking distance (postmen, couriers).Naturally, persons with alcohol dependence prohibited work in socially important areas (public transport drivers, pilots, train drivers, trains, etc.).
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