Резюме
Боброва Е.В.¹, Коломиец В.В.² Алкогольная кардиомиопатия.
В статье описаны формы поражения сердца при алкогольной интоксикации, основной из которых является алкогольная кардиомиопатия, а также влияние алкоголя на организм. Представлены этиология, патогенез и стадии алкогольной кардиомиопатии. Описаны все методы диагностики, дифференциальной диагностики алкогольной кардиомиопатии с ИБС и миокардитами, а также лечение алкогольной кардиомиопатии.
Ключевые слова: алкогольная кардиомиопатия, этиология, патогенез, клиника, диагностика, лечение.
Резюме
Боброва О.В., Коломієць В.В. Алкогольна кардіоміопатія.
У статті описані форми ураження серця при алкогольній інтоксикації, основною з яких є алкогольна кардіоміопатія, а також вплив алкоголю на організм. Представлені етіологія, патогенез та стадії алкогольної кардіоміопатії. Описані всі методи діагностики, диференціальної діагностики алкогольної кардіоміопатії з ІБС та міокардитом, а також лікування алкогольної кардіоміопатії.
Ключові слова: алкогольна кардіоміопатія, етіологія, патогенез, клініка, діагностика, лікування.
Summary
Bobrova H.V., Kolomiets V.V. Alcoholic cardiomyopathy.
The forms of heart disease in alcohol intoxication , the main of which is the alcoholic cardiomyopathy, as well as the effects of alcohol on the body describes this article. Presented the etiology, pathogenesis and stage of alcoholic cardiomyopathy. Describes all methods of diagnosis, differential diagnosis of alcoholic cardiomyopathy with coronary artery disease and myocarditis, and treatment of alcoholic cardiomyopathy.
Key words: alcoholic cardiomyopathy, the etiology, pathogenesis, clinical features, diagnosis, treatment.

Рецензент: д.мед.н., проф. Л.М. Іванова

УДК 616.127-007.61/.63-06:616.89-008.441.13-02

¹ Национальная медицинская академия последипломного образования им. П.Л. Шупика (Киев)

Shupyk National Medical Academy of Postgraduate Education

bobrova45@ukr.net

² Донецкий национальный медицинский университет им. М. Горького (Донецк)

M. Gorky Donetsk National Medical University

vvkolomiyets@i.ua

Alcoholic cardiomyopathy is a form of alcoholic cardiac lesions, observed in 50% of people abusing alcohol for a long time and one of the most common diseases caused by alcohol.

The etiologic factor in alcoholic cardiomyopathy is ethanol and / or its metabolites.

Its development can contribute to stress, insufficiency nutrition (deficiency of protein, vitamins), genetic predisposition, viral infection due to lower immunity, changes to the original state of the myocardium.

Long-term alcoholism causes fatty infiltration of the heart muscle, as well as degenerative changes in the walls of the coronary arteries and ganglia infarction.

The initial signs of the disease are palpitations and shortness of breath on exertion arising inconspicuously and without cause for the patient.

Cardiac arrhythmias with no signs of congestive heart failure are first clinical manifestation most often. Development of the disease has several stages - from disorders of cardiac rhythm resistant to myocardial hypertrophy and the subsequent development of heart failure.

Complete blood count is normal in many patients, however, after alcoholic excess perhaps moderate increase erythrocyte sedimentation rate and white blood cell count.

Characteristic changes on the ECG are shortening the interval PQ, QT interval prolongation in combination with a small ST-segment elevation and pointed high with a broad base of the T wave, sinus arrhythmia, bradycardia - tachycardia . For alcoholic cardiomyopathy especially characterized by changes in the final part of the ventricular complex, ST segment and T wave in the form of ST-segment depression below the contour lines of abnormal high, two-phase, isoelectric or negative T wave.

The main echocardiographic changes in alcoholic cardiomyopathy are:

• Dilation of all four cavities of the heart;
• global decline in ventricular function;
• mitral and tricuspid regurgitation;
• pulmonary hypertension;
• diastolic dysfunction;
• presence of intracardiac (intraatrial or intraventricular) thrombus;
• left ventricular hypertrophy.

During alcoholic cardiomyopathy distinguish 3 stages:

I stage lasts about 10 years. Complaints - the pain in heart,

heartbeat, feeling short of breath, headache , irritability , sweating, bad dream. The heart is not enlarged, tachycardia, blood pressure level is moderately elevated.

Stage II is developing alcohol abuse for over 10 years. Observed acrocyanosis, puffy face with a little exertion dyspnea, cough, swelling of the lower extremities. Increased size of the heart, deaf tones, sometimes gallops. There have been a variety of arrhythmias. The liver is enlarged in size, characterized by stagnation in the pulmonary circulation.

Stage III is the result of progressive and irreversible cardiosclerosis metabolic changes in the myocardium.

Often in conjunction with alcohol-induced cardiac dysfunction observed liver and pancreas.

Differential diagnostics alcoholic cardiomyopathy performed with coronary artery disease considering character of pain. At echocardiogram in alcoholic cardiomyopathy, in contrast to CAD, there is dilatation of the heart with decreased myocardial contractility, with no focal character.

Treatment starts with the prohibition of alcohol. In the early stages with no evidence of heart failure and the presence of false angina, tachycardia, hypertension and arrhythmias recommended beta-adrenergic blockers. In severe cardiomegaly should be administered cardiac glycosides, but it is necessary to strictly control their reception. In the complex treatment includes diuretics, vitamins, anabolic hormones, potassium and magnesium salts.

Patient assigned to the complex:

• B vitamins ( without exception );
• Cocarboxylase;
• Pananginum, potassium chloride, potassium orotate (all drugs belong to a group of potassium).

Less commonly prescribed angiotensin-converting enzyme.

Alcoholic cardiomyopathy is well treated with stem cells which contribute to the renewal of cardiomyocytes, which improves the activity of the heart and prevents the development of cardiomyopathy.

When none of the methods or their combination has not positive effect the desired result carried the surgical treatment.

Литература

1. Скворцов Ю.И. Алкоголь и сердце: механизмы воздействия, клиника, лечение / Ю.И. Скворцов, Л.Ф. Панченко, К.Ю. Скворцов. - Саратов : Издательство Саратовского медицинского университета, 2004. - 103 с.
2. Ивашкин В.Т. Алкогольная кардиомиопатия / В.Т. Ивашкин, О.М. Драпкина, Я.И. Ашихмин [Электронный ресурс]. – Режим доступа : http://copy.yandex.net/?text
3. Ивашкин В.Т. Алкогольная кардиомиопатия / В.Т. Ивашкин, О.М. Драпкина, Я. Ашихмин // Клиническая медицина. – 2006. – № 3. – С. 11–15.
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5. Acetaldehyde-induced cardiac contractile dysfunction may be alleviated by vitamin B1 but not by vitamins B6 or B12 / N.S. Aberle, L. Burd, B.H. Zhao [et al.] //Alcohol & Alcoholism. – 2004. – Vol. 39, № 5. – P. 450–454.
6. Biphasic changes in cardiac excitationcontraction coupling early in chronic alcohol exposure / G.L. Aistrup, J.E. Kelly, M.R. Piano [et al.] // Am. J. Physiol. Heart Circ. Physiol. – 2006. – Vol. 291. – P. H1047–H1057.