Peripheral edema with alcoholism. Quasi-ischemic alcoholic cardiomyopathy
Along with stagnation in the lungs and enlarged liver peripheral edema gradually develops: first the pastosity of the shins, then the fairly common swelling of the legs, the area of the sacrum, the anterior abdominal wall. Free fluid begins to be determined in the abdominal cavity, usually in a small amount. In severe cases, marked ascites and fluid in the pericardial cavity are noted. Often revealed phlebothrombosis of the legs with subsequent microemboli in the small circle of blood circulation, but possible and arterial thromboembolism, which are one of the causes of death of patients.
Often, death occurs due to a sudden development of cardiovascular collapse.
The resulted clinical picture severe alcoholic cardiomyopathy in generalcoincides with the classical descriptions of J. Mackenzie and N. Vaques, in connection with which EM Tareyev and AS Mukhin (1977) propose to characterize it as the "classical form" of alcoholic cardiomyopathy. Along with this form they also distinguish quasi-ischemic and arrhythmic forms of cardiomyopathy in alcoholism. As for the so-called arrhythmic form of alcoholic cardiomyopathy, references to the paroxysmal and then permanent form of atrial fibrillation are found in the descriptions of Q. Steell (1893), J. Mackenzie (1902), N. Vaquez (1921) and other authors.
W. Evans (1959, 1961), who created the modern the doctrine of alcoholic cardiomyopathy. focuses on atrial fibrillation, andalso on paroxysmal tachycardia as one of the main symptoms of an alcoholic heart. Thus, it hardly makes sense to single out a variant of alcoholic cardiomyopathy, which proceeds with a heart rhythm disorder, into a separate form, since arrhythmia, especially atrial fibrillation, is a very frequent component of cardiomyopathy. In this regard, it is important to consider only two circumstances.
First, a person suffering from "hidden" alcoholism. often only after sufficientsevere arrhythmia (paroxysmal tachycardia or atrial fibrillation) first addresses to the doctor. In this case, it is very important to establish the true cause of the rhythm disorder, which is not always possible. Secondly, very often paroxysm of tachycardia or atrial fibrillation is the reason for the transition of latent alcoholic cardiomyopathy into its explicit form.
The third, quasi-ischemic, form of alcoholic cardiomyopathy most difficult to diagnose, especially in individualsmiddle and old age, since in each case, even in the presence of an alcoholic history, coronary atherosclerosis and alcoholism should be differentiated. In the opinion of EM Tareev and AS Mukhin, this form is the most common, but is rarely diagnosed. In contrast to classical alcoholic cardiomyopathy with quasi-ischemic form, along with palpitation and dyspnea, patients complain of pain in the heart area, behind the breastbone, and the electrocardiogram shows changes similar to those in coronary disease (R. Haasis, IX Larbig and D. Jeschke, 1976).
In most cases, classical angina pectoris symptoms these patients do not have functional andpharmacological tests (potassium, obzidanova, nitroglycerin) also do not give grounds to diagnose coronary heart disease. The ethanol test proposed by EM Tareev and AS Mukhin is accompanied by a worsening of the electrocardiogram, but this is generally quite natural, since intravenous injection of ethyl alcohol to patients with heart diseases causes the S-T interval to drop. Only a thorough complex examination and dynamic observation make it possible to reliably diagnose alcoholic cardiomyopathy in such cases.
Occasionally the patient enters hospital with characteristic angina pectorisalcoholic intoxication) and electrocardiographic signs of damage to one or another part of the myocardium (VA Barchuk, VV Karpov and BD Skornetsky, 1973), but rapid (within a few days) normalization of the electrocardiogram, negative results of biochemical tests, alcoholic excesses immediately before the onset of the disease can exclude acute myocardial infarction and diagnose alcoholic heart damage.
It should be emphasized that quasi-ischemic form of alcoholic cardiomyopathy usually occurs against a background of more or less pronounced stagnant cardiomyopathy, to which a painful and (or) electrocardiographic syndrome resembling coronary disease joins.