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Alcoholic Cardiomyopathy — EECC MCQ

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EasyCardiomyopathyAlcoholic CardiomyopathyEECC

A 55-year-old man with a 30-year history of alcohol excess (>14 units/day) presents with heart failure. Echocardiography shows a dilated LV (LVEDD 70 mm) with LVEF 20% and global hypokinesis. He has no coronary artery disease on angiography. What is the most important management recommendation specific to his cardiomyopathy aetiology?

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Correct answer: A — Complete and permanent alcohol abstinence

Alcoholic cardiomyopathy (ACM) is a reversible cause of dilated cardiomyopathy. Complete abstinence from alcohol is the single most important intervention and can lead to significant improvement or even normalisation of LV function, particularly in the first 6 months. Partial reduction in alcohol intake is insufficient and associated with worse outcomes compared to complete abstinence. Thiamine supplementation is important as a co-intervention (wet beriberi can compound cardiac dysfunction) but does not replace abstinence. Standard HF therapy (GDMT) should be initiated concurrently. ICD implantation should be deferred for at least 3-6 months of abstinence and optimal medical therapy to allow for potential recovery.

Reference: ESC (2023): Guidelines on Cardiomyopathies