Spectrum of heart muscle abnormalities related to alcoholism

To assess the diastolic and systolic performance characteristics of the left ventricle in alcoholism, three patient groups with a history of heavy alcohol consumption were compared with normal subjects. In those with symptoms related to chest pain or palpitations, heart size was normal on x ray. In groups III and IV, dyspnea was associated with varying degrees of cardiomegaly and a high prevalence of absent septal Q on the ECG. Despite substantial differences in physical findings, all three groups exhibited a significant increase in end‐diastolic pressure. Group I was distinguished by the fact that end‐diastolic volume was not increased but actually somewhat diminished. Groups II and III were characterized by a significant increase in end‐diastolic volume and tension. The latter was enhanced to a significantly greater extent in group III and was the most prominent hemodynamic abnormality in this group. A major change in the index of contractility, as well as in the rate of relaxation, occurred in group I. Further moderate depression of these indices was observed in the groups with enhanced diastolic volume. In the patients who had mitral regurgitation a more severe depression of left ventricular function was present in the alcoholic group than in a nonalcoholic control group, and was presumably due to the toxic effects of ethanol on the left ventricle. Thus, in those alcoholic patients who develop cardiac alterations, the earliest abnormality is characterized by diminished left ventricular compliance and a moderate contractility deficit without heart failure. In those who progress, end‐diastolic tension is substantially enhanced and further reduction in contractility indices is observed. The potential for reversibility is discussed.