--- title: Alcoholic cardiomyopathy description: How long-term heavy drinking weakens the heart muscle, why atrial fibrillation can follow a binge, how this is investigated, which treatment approaches the clinical guidelines describe, and when to call an ambulance. type: disease preset: atrial-fibrillation aliases: - alcohol-induced cardiomyopathy - alcohol-related cardiomyopathy - alcoholic dilated cardiomyopathy - holiday heart - atrial fibrillation after binge drinking sources: - tier: guideline org: minzdrav-rf title: Дилатационная кардиомиопатия year: 2025 url: https://cr.minzdrav.gov.ru/view-cr/1008_1 - tier: guideline org: esc title: 2024 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS year: 2024 doi: 10.1093/eurheartj/ehae176 url: https://doi.org/10.1093/eurheartj/ehae176 - tier: guideline org: minzdrav-rf title: Фибрилляция и трепетание предсердий year: 2025 doi: 10.15829/1560-4071-2025-6668 url: https://cr.minzdrav.gov.ru/view-cr/382_2 - tier: guideline org: esc title: 2023 ESC Guidelines for the management of cardiomyopathies year: 2023 doi: 10.1093/eurheartj/ehad194 url: https://doi.org/10.1093/eurheartj/ehad194 - tier: reference org: msd-manuals title: Dilated Cardiomyopathy (MSD Manual Professional Version) year: 2026 url: https://www.msdmanuals.com/professional/cardiovascular-disorders/cardiomyopathies/dilated-cardiomyopathy - tier: reference org: msd-manuals title: Atrial Fibrillation (MSD Manual Professional Version) year: 2024 url: https://www.msdmanuals.com/professional/cardiovascular-disorders/specific-cardiac-arrhythmias/atrial-fibrillation - tier: guideline org: who title: Alcohol (WHO fact sheet) year: 2024 url: https://www.who.int/news-room/fact-sheets/detail/alcohol sources_checked: 2026-10-14 review: null --- Alcoholic cardiomyopathy is a disease of the heart muscle in which, after long-term heavy drinking, the left ventricle (or both ventricles) becomes dilated and contracts less well, with no other known cause. In essence it is one form of [dilated cardiomyopathy](../dilated-cardiomyopathy/), and long-term excessive drinking is one of its most frequent causes. Alcohol also affects the heart in another way: a binge can trigger an episode of [atrial fibrillation](../atrial-fibrillation/). The most important thing to know: if a person stops drinking completely, the heart's function can improve, sometimes back to normal.

Normally the left ventricle is not dilated and squeezes strongly with each contraction, pushing blood into the aorta. It is dilation of the ventricle and weakening of its contraction that mark dilated cardiomyopathy, including the alcoholic form.

In alcoholic cardiomyopathy, after long-term heavy drinking, the left ventricle, and sometimes both ventricles, are dilated and squeeze weakly; the left ventricular ejection fraction is reduced.

## Why it happens Alcohol and the substance the body turns it into (acetaldehyde) directly damage the cells of the heart muscle. They damage the proteins that make the muscle contract, and over time inflammation and scar tissue develop in it. The heart becomes weaker and its chambers stretch. It most often affects men who have drunk heavily for many years; in women the disease develops at lower amounts of alcohol than in men. Heredity matters too: alcohol does not harm the heart equally in people with different genes. There is a health risk even at low levels of drinking, although most harm comes from binge drinking and from heavy continuous drinking. Alcohol is linked to heart rhythm in two ways. A binge can trigger atrial fibrillation; this is called "holiday heart". And with regular drinking, the risk of atrial fibrillation rises with the amount drunk. Alcoholic cardiomyopathy has its own ICD code, I42.6. A clinical diagnosis can be made when there is dilation of the left or both ventricles with impaired systolic function against a background of long-term consumption of alcohol in significant amounts and in the absence of other known causes. It occurs most often in men aged 30–55 who have misused alcohol for more than 10 years; about 14% of cases are in women, in whom it develops at lower amounts of alcohol. The European guidelines list alcohol (ethanol) among the toxic non-genetic causes of DCM. Pathogenesis according to the Russian Ministry of Health guideline: ethanol and its metabolites, above all acetaldehyde, have a direct toxic effect on cardiomyocytes, damage the alpha-myosin heavy chains and reduce contractility, disturb membrane permeability to ions and stimulate the sympathetic nervous system; the result is fatty degeneration and apoptosis of cardiomyocytes, a severe inflammatory reaction of the myocardium, and fibrosis. Genetic predisposition plays a role: a common form of it is truncating variants of the titin gene (TTN). Chronic alcohol misuse can lead to thiamine deficiency, which can itself cause or contribute to cardiomyopathy. The 2024 ESC guidelines define trigger-induced AF: new AF in the immediate association of a precipitating and potentially reversible factor; binge alcohol consumption is listed among the acute conditions. MSD lists binge drinking ("holiday heart") among the most common causes of AF. Observational studies link alcohol to an excess risk of incident AF in a dose-dependent manner. ## Symptoms The symptoms are no different from other forms of dilated cardiomyopathy. They are signs of [heart failure](../heart-failure/): breathlessness on exertion, breathlessness when lying down and at night, tiring easily, reduced exercise tolerance, and swelling of the lower legs and ankles. Heart rhythm problems are common, most often atrial fibrillation. The heart disease is often found by chance, before any symptoms of heart failure, when a person is examined for another reason: the ECG shows extra beats, atrial fibrillation or other changes. Atrial fibrillation is felt as palpitations, sometimes with weakness, breathlessness, reduced exercise tolerance and feeling faint; clots can form in the atria and raise the risk of stroke. Alcohol damages not only the heart but also the liver, the nervous system, the muscles, the pancreas and the gut. The clinical features of alcoholic cardiomyopathy are non-specific and the same as in DCM: HF and various arrhythmias, most often AF. In the early stages, before HF symptoms, there may be cardialgia and ECG changes: ectopic beats, AF, ST-segment and T-wave changes. ## How it is diagnosed The tests are the same as for [dilated cardiomyopathy](../dilated-cardiomyopathy/): the main test is an ultrasound scan of the heart (echocardiography), and everyone also has an ECG. The doctor will always ask how much and for how long the person has been drinking, and whether relatives have had problems with alcohol. Alcoholic cardiomyopathy is diagnosed when the ventricle is dilated and contracts weakly, the person has drunk a lot of alcohol for a long time, and no other cause has been found. People often do not admit to heavy drinking, so the doctor also looks at other signs, including changes in blood tests. Being honest about alcohol helps find the cause of the heart disease. In atrial fibrillation, too, the doctor looks for causes that can be removed, and alcohol is one of them. A history of alcohol and drug use, including a family history of alcohol dependence, is recommended for all patients with suspected DCM; echocardiography for all with suspected DCM, and a 12-lead ECG for all with DCM. Echocardiographic criteria for DCM in the Russian Ministry of Health guideline: LV end-diastolic volume index ≥75 mL/m² in men and ≥62 mL/m² in women; LVEF ≤40% or 41–49%. In alcoholic cardiomyopathy, some patients show a tendency towards myocardial hypertrophy on echocardiography early in the disease; otherwise the work-up does not differ from that recommended for DCM. Patients often deny alcohol misuse; it is suggested by the stigmata of chronic alcohol intoxication and by laboratory changes: macrocytosis, raised gamma-glutamyl transferase and a reduced De Ritis ratio. A search for reversible risk factors for AF, including alcohol, is one of the quality-of-care criteria in the Ministry's AF guideline. ## How it is treated The key to treatment is stopping alcohol completely, together with the usual treatment of [heart failure](../heart-failure/). After a person stops drinking, the function of the left ventricle can recover, and with early abstinence even return fully to normal. Even if it does not fully return to normal, the symptoms of heart failure lessen after stopping alcohol. If the person keeps drinking, the outlook remains poor. If you find it hard to stop drinking on your own, tell your doctor. If atrial fibrillation was caused by alcohol intoxication, the rhythm may return to normal on its own once the cause is removed; how to treat the episode and whether anti-clotting medicines are needed is for the doctor to decide. For people with atrial fibrillation, drinking less helps make episodes come back less often: it is part of treatment, alongside controlling blood pressure and weight. In atrial fibrillation, alcohol can raise the risk of clots and stroke, and excess drinking in people taking anti-clotting medicines raises the risk of bleeding; stopping alcohol after atrial fibrillation is diagnosed can lower the risk of stroke. Do not start, stop or change medicines on your own. Russian Ministry of Health guideline: treatment of alcoholic cardiomyopathy should begin with complete abstinence from alcohol in addition to conventional HF treatment; complete abstinence is recommended to reduce the severity of LV systolic dysfunction, which may be reversible (Russian Society of Cardiology class I, level B; grade of recommendation C, level of evidence 5). Reversibility of LV dysfunction, up to full recovery with early abstinence, has been noted in numerous observations; if the patient does not stop drinking, mortality reaches 40–50% within 3–6 years. In its general advice for cardiomyopathies, the 2023 ESC guideline says to avoid excess alcohol intake. Specific drugs and doses are not given here. Trigger-induced AF: the Ministry's AF guideline considers pharmacological or electrical cardioversion inappropriate when AF is due to a transient reversible factor, including alcohol intoxication, because of the high risk of early recurrence before the cause is removed. The ESC recommends managing such AF according to the AF-CARE principles: based on retrospective and observational data, these patients seem to carry the same thromboembolic risk as patients with primary AF. Reducing alcohol consumption is recommended (class I) as part of comprehensive risk factor management to reduce AF recurrence; in an RCT among regular non-binge drinkers with AF, the goal of abstinence led to a significant reduction in AF recurrence and burden. The Ministry's AF guideline recommends controlling provoking factors for AF, including alcohol, discussing abstinence with patients on oral anticoagulants, and counts stopping alcohol among the health indicators monitored during follow-up. ## When to call an ambulance In dilated cardiomyopathy, including the alcoholic form, dangerous arrhythmias, thromboembolism and sudden cardiac death can occur. Call your local emergency number (112 in the EU, 911 in the US and Canada, 999 in the UK) if there are signs of acute heart failure (severe shortness of breath or choking, especially when lying down), fainting or chest pain. Also call if there is a fast, irregular heartbeat with breathlessness, chest pain or severe weakness: atrial fibrillation with a very fast rate can cause chest discomfort, weakness and breathlessness. For the signs of stroke in atrial fibrillation, see the article on [atrial fibrillation](../atrial-fibrillation/); for sudden severe breathlessness, see the article on [heart failure](../heart-failure/). As with any heart disease, call for emergency help if someone faints or has chest pain or severe shortness of breath: this is the site's general safety rule, repeated at the bottom of every page.