Anticardiolipin antibodies associated with alcoholic cardiomyopathy.

Anticardiolipin antibodies are associated with arterial and venous thrombosis, and repetitive miscarriages. The involvement of the heart has been described frequently and can evolve into cardiomyopathy. It has been known for some decades that chronic alcoholism can lead to alcoholic cardiomyopathy (ACM). The objective of this study was to evaluate whether anticardiolipin antibodies represent a worse prognosis for patients with ACM. The authors present a case of a chronic alcoholic patient (30 y of alcoholism) who died at 44 y of age, and who was considered positive for anticardiolipin antibodies. The patient developed deep vein thrombosis, and peripheral arterial and pulmonary embolism. The presence of another risk factor seems to represent a worse prognosis for patients with ACM.

O significado da abstinência do álcool na cardiomiopatia alcoólica com disfunçäo ventricular moderada / The significance of alcohol abstinence in alcoholic cardiomyopathy with moderate left ventricular dysfunction

Objetivo - Avaliar o papel da abstenção alcoólica, no período de 12 meses, na cardiomiopatia alcoólica (CMA) com disfunção ventricular de grau moderado, em pacientes tratados com esquema anticongestivo. Métodos - Estudo observacional prospectivo com 20 pacientes com CMA, 9 (45%) na classe funcional (CF) II e 11 (55%) na CF III, 16 (80%) homens, predomínio de negros (55%), de 35 a 56 (x=45) anos, com consumo pesado de álcool (>80g etanol/dia), por período de 51 a 112 (x=85) meses, que concordaram, inicialmente, em particular de programa de apoio, com psicoterapia de grupo, além do acompanhamento clínico com realização de exames não invasivos, antes do início do programa e após 12 meses da terapia, e foram divididos em dois grupos, o 1 (G-I) constituído pelos que atingiram a abstinência e o 2 (G-II) pelos não abstêmios. Resultados - Após 12 meses, 11 (55%) pacientes permaneciam em terapia de apoio, 8 (72,72%) no G-I, enquanto os 9 (45%) que não se mantiveram no programa, apenas 2 (22,22%) tinham logrado abstinência (G-I). Ao fim da avaliação, alcançamos número igual de pacientes entre os grupos. Comparando os grupos observamos: a) menores valores médios dos diâmetros sistólicos (DSVE) e diastólico (DDVE) do ventrículo esquerdo no G-I; b) maior número de internações no G-II (3) em relação ao G-I (1); c) na evolução clínica, maior número de pacientes do G-I, entre os que apresentaram melhoras (3 G-I e 1 G-II) e que permaneceram inalterados (6 G-I e 3 G-II), além do maior número de pioras entre o G-II (1 G-I e 5 G-II). Conclusão - Apesar do desejo inicial favorável, a abstinência só foi obtida em 50% dos pacientes com CMA e disfunção ventricular moderada, porém, quando alcançada, apresentou melhor evolução (melhoras + inalterados = 90%), com maior redução do DSVE e do DDVE (p<0,001), devendo sempre ser perseguida mesmo na presença de moderada disfunção ventricular.

[Significance of alcohol abstinence in alcoholic cardiomyopathy with moderate left ventricular dysfunction]. / O significado da abstinência do alcool na cardiomiopatia alcoólica com disfunção ventricular moderada.

PURPOSE: To evaluate the role of a 12 month alcohol abstinence period in patients with moderate left ventricular dysfunction treated with anticongestive therapy. METHODS: Prospective observational study with 20 patients with alcoholic cardiomyopathy (ACM), 9 (45%) in functional class (FC) II and 11 (55%) in FC III, 16 (80%) men, mostly black (55%), from 35 to 56 (x = 45) years old, heavy alcohol users (> 80 g ethanol for 51 to 112 (x = 88) months. At the beginning, all agreed to participate with psychotherapy and clinical evaluation. After 12 months, they were divided in G-I, formed by those who remained abstemious and G-II of non-abstemious. RESULTS: After 12 months, among the 11 (55%) who remained in psychotherapy, 8 were in G-I, among those who did not 9 (45%), only 2 (22.22%) remained abstemious (G-I). At the end of the evaluation period, both groups had the same number of patients. Comparing them, we observed: a) lower mean systolic and diastolic left ventricular diameters in G-I; b) more hospitalizations in G-II (3); c) more patients with stable or better clinical evaluation in G-I. CONCLUSION: Despite the initial will, only 50% reached abstinence. When it was reached, patients had a better evolution in left ventricular systolic diameter and abstinence should always be tried even in the presence of moderate left ventricular dysfunction.

Enfermedad cardiaca alcoholica / Alcoholic heart disease

El tema de mi presentación es "enfermedad cardiaca alcohólica" o "cardiomiopatía alcohólica". La O.M.S. ha reservado la nomenclatura de "cardiomiopatía para la enfermedad del músculo cardiaco de etiología desconocida, por lo que yo prefiero utilizar el término enfermedad cardiaca alcohólica en la misma forma que enfermedad cardiaca post-parto

[Association of myopathies and alcoholic cardiomyopathy: clinical, electroneuromyographic and histopathologic study of the skeletal muscle in 10 cases of alcoholic cardiomyopathy]. / Associação de miopatia e miocardiopatia alcoólicas: Estudo clínico, eletroneuromiográfico e histopatológico do músculo esquelético em 10 casos de miocardiopatia alcoólica.

Myocardial and skeletal muscle impairment caused by alcohol has been thoroughly studied. Nevertheless, the simultaneous involvement of those tissues by ethanol has not been broached in medical literature. We have studied ten patients undergoing alcoholic cardiomyopathy. They were subjected to a detailed neurological examination, muscle enzymes serum level determinations, electromyography, and muscle biopsy with analysis of the tissue by usual histological techniques and by electron microscopy. Only one of ten patients exhibited proximal weakness and atrophy of the lower limbs, the electromyographic and histological findings correlating with the clinical feature of the chronic muscle disease due to alcohol consumption. The electromyographic findings included muscle disease in eight patients, neuron disease in one patient and no changes at all in the tenth patient. In one patient only, the skeletal muscle proved normal when examined by conventional histological techniques. In the other nine patients there were several minimal changes, such as the proliferation of nuclei beneath the sarcolemma, atrophy of fibers, hyalinization, vacuolation, loss of muscle fiber striae, and atrophy of groups of fibers. Electron microscopy demonstrated the following changes in nine patients: intracellular edema, dissociation of myofilaments, alteration of the Z line, changing in the shape and increase in the number of mitochondria, thickening of sarcolemma, and vacuolation and increase of the glycogen granules. Since all patients exhibited skeletal muscle injury, we concluded that there is a close relation between alcoholic cardiomyopathy and skeletal muscle disease.

Beriberi cardíaco: relato de um caso da forma fulminante (shoshin) e revisäo de literatura / Cardiac beriberi: report of a case of fulminant (shoshin) and review of the literature

Um paciente de trinta anos, alcoolista, portador de insuficiência cardíaca congestiva de alto débito, sopro cardíaco, polineuropatia e acidose é apresentado como um caso da forma fulminante de beriberi cardíaco (Shoshin). Inicialmente o paciente foi tratado como sendo portador de cardiopatia reumática com repouso, restriçäo salina, digoxina e diuréticos, sem ter melhorado. Com a introduçäo de tiamina ao esquema terapêutico, houve regressäo rápida do quadro cardiovascular. É apresentado o histórico da doença, juntamente com uma discussäo dos critérios utilizados para o diagnóstico. Enfatiza-se também a importância de se considerar a deficiência tiamínica como causa de insuficiência cardíaca, tendo em vista a alta prevalência do alcoolismo em nosso meio

[Importance of various myocardial factors in "primary" congestive cardiomyopathies]. / Importancia de algunos factores miocardiopáticos en las cardiomiopatías congestivas "primarias".

Thirty one cases of congestive cardiomyopathy previously diagnosed as "idiopathic" were retrospectively studied in order to determine the prevalence of the following pathologic myocardial factors (MFs): severe alcoholism (A), systemic arterial hypertension (SAH) and obstructive coronariopathy (OC). Sixteen (51%), 14(45%) and 9(29%) cases had an association with A, SAH and OC, respectively. Any of these MFs was present in 48% of cases, 2 of them in 19% and 3 in 13% of cases. Some peculiarities of the clinical findings, a particular interpretation of such findings by the attending physician and a modification of the psychological status of some patients were the main causes which prevented the recognition of these MFs. Besides, 67% of the cases had at least one of the following "minor" factors which contributed to the myocardial damage: mitral insufficiency, pulmonary embolism, atrial-ventricular block and diabetes mellitus. A careful investigation of these MFs should be done before a diagnosis of idiopathic congestive cardiomyopathy is considered. In some cases there is more than one pathogenic factor.

[Primary alcoholic cardiac disease and alcoholic liver disease. Anatomopathological study]. / Enfermedad cardíaca alcohólica primaria y enfermedad hepática alcohólica. Estudio anatomopatológico.

In order to find out if there is an association between alcoholic heart disease and alcoholic liver disease, and to discover the prevalence and characteristics of anatomical findings in the heart at alcoholic subjects, a prospective study was realized during the autopsies of patients younger than 60 years old, who had died with alcoholic liver disease not associated with an obvious heart disease. A second group of subjects containing similar characteristics of the first group, only without a past history of alcoholism nor liver disease, were used as controls. The comparison between the two groups in respect to: age, nutritional status, macroscopic and microscopic findings of the heart, frequency and degree of atherosclerosis revealed no statistical difference. In conclusion, we submit that the subjects who had died from liver disease also presented myocardial alterations, but that these did not differe from those observed in the control subjects.