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Heart Risks and Chronic Alcohol Abuse: Understanding Alcoholic Cardiomyopathy

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Alcoholic cardiomyopathy describes the cardiac disease associated with chronic alcohol misuse. Alcoholic cardiomyopathy (not to be confused with alcoholic myopathy) reduces the heart’s ability to pump blood efficiently and can lead to heart failure, which may also affect other parts of the body. 1

In this article: 

How Does Alcoholic Cardiomyopathy Occur?

Alcoholic cardiomyopathy (ACM) is a form of heart disease caused by alcohol misuse. Individuals who binge drink frequently over a long period of time or who have alcohol use disorder (AUD) may develop ACM. Chronic alcohol misuse weakens the heart muscle, preventing it from pumping blood efficiently. When your heart cannot pump enough blood, the lack of blood flow disrupts your major body functions. This can lead to heart failure and other serious and potentially life-threatening health problems.2

According to the American Heart Association, there are several different types of cardiomyopathy. Alcoholic cardiomyopathy is a type of dilated cardiomyopathy (DCM), which is the most common type. DCM happens with the left ventricle of the heart becomes enlarged—or “dilated”—which thins and weakens the muscle. The right ventricle may or may not also become enlarged. 1

ACM is an “acquired” type of cardiomyopathy because it develops over time due to the long-term effects of alcohol misuse. Other types of cardiomyopathy are congenital or hereditary.3

Another speculated cause of ACM is vitamin B1 (thiamine) deficiency. Vitamin B1 deficiency is common among people who misuse alcohol. When vitamin B1 levels become deficient, the production of vital cellular compounds that assist with muscle contractions, nerve impulses, and chemical processes becomes unbalanced. The heart attempts to compensate by straining to pump a higher blood volume. However, this high-output state is not sustainable and weakens the heart muscle, which can increase the risk of developing ACM.4

What Are the Risk Factors for Alcoholic Cardiomyopathy?

Alcoholic cardiomyopathy is seen most commonly in middle-aged adults who misuse alcohol over a period of years. The number of years and amount of alcohol it takes to develop ACM is unknown. However, some researchers estimate at least five years of daily drinking significantly increases a person’s risk for ACM.5

People who misuse alcohol for a long time are more likely to develop physical dependence and pharmacological tolerance to alcohol. Physical dependence means that the person needs to use alcohol in order not to experience withdrawal symptoms, while the amount of alcohol necessary grows as the individual’s tolerance increases. Physical dependence and tolerance may occur as part of, or as precursors to, AUD.

In Western countries, it is estimated that up to 10% of the adult population suffers from AUD. The highest prevalence is observed later in life, but AUD affects all races, ethnic groups, and socioeconomic statuses.1

Alcohol misuse includes any alcohol use that puts your health or safety at risk or causes other alcohol-related problems. According to the DSM-5, AUD can be categorized as mild, moderate, or severe, based on the following criteria:6

  • Being unable to limit the amount of alcohol you drink
  • Wanting to cut down on how much you drink or making unsuccessful attempts to do so
  • Spending a lot of time drinking, getting alcohol, or recovering from alcohol use
  • Feeling a strong craving or urge to use alcohol
  • Failing to fulfill major obligations at work, school, or home due to alcohol use
  • Continuing to use alcohol even though you know it is causing physical, social, or interpersonal problems
  • Giving up or reducing social and work activities and hobbies
  • Using alcohol in situations where it is not safe, such as when driving or swimming
  • Developing a tolerance to alcohol, so you need more to feel its effect or you have a reduced effect from the same amount
  • Experiencing withdrawal symptoms—such as nausea, sweating, and shaking—when you don’t use alcohol

If you feel that you cannot control your alcohol intake, your drinking is causing problems, or your friends and family are concerned about your drinking, call 800-948-8417 Question iconCalls are forwarded to these paid advertisers to speak to an addiction treatment specialist. Receiving help for your alcohol misuse is a concrete step you can take to reduce your risk of developing alcoholic cardiomyopathy.

What Are the Signs and Symptoms of Alcoholic Cardiomyopathy?

If you experience any of the following effects of heart problems, seek medical attention. Your doctor may use echocardiography (EKG) to determine if there is mild or severe strain on your cardiac function.

Short-term effects of ACM and other cardiac problems include:2

  • Shortness of breath
  • Fatigue
  • Weakness
  • Dizziness or fainting
  • Loss of appetite
  • Trouble concentrating
  • A rapid and irregular pulse

Alcoholic cardiomyopathy may not cause any symptoms until the disease becomes advanced. At that point, the symptoms are often the result of heart failure.

Long-term or advanced effects of ACM are similar to those of congestive heart failure and can include:2

  • Ankle, feet, and leg swelling (edema)
  • General swelling
  • Shortness of breath (dyspnea), especially with activity
  • Breathing difficulty while lying down (orthopnea)
  • Fatigue, weakness, or faintness
  • Decreased alertness or concentration
  • Cough containing mucus, or pink, frothy material
  • Decreased urine output (oliguria)
  • Frequent need to urinate at night (nocturia)
  • Heart palpitations (irregular heartbeat)
  • Rapid pulse (tachychardia)

Not everyone who misuses alcohol will develop ACM, but it can be serious or even life-threatening if it does occur. Problems that can occur with ACM include:5

  • Heart valve problems
  • Blood clots in the heart
  • Irregular heartbeats
  • Heart failure

How Is Alcoholic Cardiomyopathy Treated?

If you suspect you at risk of or are suffering from the early stages of alcoholic cardiomyopathy, your doctor will run tests to make an accurate diagnosis. Your doctor will also ask you about your medical history and alcohol use behaviors. It is important to be honest with your doctor about your alcohol use, including the number and amount of drinks you have each day. This will make it easier for them to make an accurate diagnosis and develop a treatment plan.

Alcoholic cardiomyopathy is preventable and reversible using various treatment methods. Treatment for ACM involves lifestyle changes, including:5

  • Abstinence from alcohol
  • A low-sodium diet
  • Fluid restriction
  • Medication

Medications may include ACE inhibitors, beta-blockers, and diuretics, which are commonly used to reduce the strain on the heart when treating cardiomyopathies. However, dietary changes and medication are usually only effective when combined with or implemented following treatment for alcohol misuse.

For people at high risk of severe withdrawal from alcohol, several days of detox or inpatient treatment—either in a hospital setting or long-term rehabilitation facility—may be required to ensure you are medically stable. After the alcohol detox, a more in-depth recovery process can take place. Typical treatment options for alcohol recovery include:

Recovery is highly individualized and may or may not include medication-assisted treatment (MAT).

After a person with AUD completes a rehab program, they may need aftercare support. Many treatment programs offer ongoing support groups that continue to meet and provide peer support or recommend attending community support groups like Alcoholics Anonymous (AA). If you have alcoholic cardiomyopathy, you may benefit from attending group support meetings for people struggling with AUD and subsequent ACM.

Alcoholic cardiomyopathy is a serious health issue and treating the root cause is important. If you or someone you know has ACM or is displaying signs of AUD, help is available. You can call our support specialists at 800-948-8417 Question iconCalls are forwarded to these paid advertisers to get help today.


  1. Guzzo-Merello, G., Cobo-Marcos, M., Gallego-Delgado, M., & Garcia-Pavia, P. (2014). Alcoholic cardiomyopathy. World Journal of Cardiology, 6(8), 771-781.
  2. Mirijello, A., Tarli, C., Vassallo, G. A., Sestito, L., Antonelli, M., d’Angelo, C., Ferrulli, A., De Cosmo, S., Gasbarrini, A., Addolorato, G., (2001). Alcoholic cardiomyopathy: What is known and what is not known. European Journal of Internal Medicine, 43, 1-5.
  3. American Heart Association. Cardiomyopathy.
  4. Helali, J., Park, S., Ziaeian, B., Han, J. K., & Lankarani-Fard, A. (2019). Thiamine and Heart Failure: Challenging Cases of Modern-Day Cardiac BeriberiMayo Clinic proceedings. Innovations, quality & outcomes3(2), 221–225.
  5. MR;, P. (2002). Alcoholic cardiomyopathy: incidence, clinical characteristics, and pathophysiology. Chest Journal, 121(5), 1638-1650.
  6. Mayo Foundation for Medical Education and Research. (2018). Alcohol use disorder.
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