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Alkoholische Kardiomyopathie

Alcoholic cardiomyopathy

Zusammenfassung

Der Alkoholabusus ist die häufigste Ursache einer sekundären Kardiomyopathie. Man geht davon aus, dass der Konsum von >90 g reinem Alkohol pro Tag über einen Zeitraum >5 Jahren bei entsprechender Disposition eine alkoholische Kardiomyopathie (ACM) induzieren kann. Die dabei zugrunde liegenden molekularen Mechanismen sind komplex und beeinflussen zahlreiche zelluläre Vorgänge wie die intrazelluläre Energiegewinnung, die Kalziumhomöostase sowie die Funktion des kontraktilen Apparates. Darüber hinaus scheint es interindividuelle Unterschiede in der Sensitivität gegenüber den toxischen Effekten des Alkohols zu geben, was die Bedeutung genetischer und weiterer umweltbedingter Faktoren in der Pathogenese der ACM hervorhebt. Die Diagnosestellung bleibt aufgrund fehlender spezifischer Zeichen schwierig und beruht auf der Koinzidenz eines Alkoholabusus und einer ätiologisch ungeklärten dilatativen Kardiomyopathie. Eine künftige Alkoholabstinenz sowie die Verwendung einer spezifischen Herzinsuffizienztherapie sind für eine Verbesserung der linksventrikulären Pumpfunktion und der individuellen Prognose von größter Bedeutung.

Abstract

Long-term alcohol abuse is the leading cause of a secondary cardiomyopathy. In general, alcoholic patients consuming >90 g alcohol per day for more than 5 years are at risk for developing an alcoholic cardiomyopathy (ACM). The underlying pathophysiology is complex and involves many aspects of cardiomyocyte function, such as impaired intracellular energy generation, calcium homeostasis and myofibrillar force generation. Clinical data suggest that there are interindividual differences in the susceptibility to alcohol-induced myocardial damage, which emphasizes the importance of genetic and environmental traits in the pathogenesis of ACM. Since there are no specific signs of ACM, diagnosis remains difficult and basically relies on the coincidence of alcohol abuse and dilated cardiomyopathy. Alcohol abstinence, as well as the use of specific heart failure pharmacotherapies, is critical in improving ventricular function and outcomes in these patients.

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Correspondence to M. Rosenberg.

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Rosenberg, M., Frey, N. Alkoholische Kardiomyopathie. Kardiologe 4, 55–64 (2010). https://doi.org/10.1007/s12181-009-0218-x

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  • DOI: https://doi.org/10.1007/s12181-009-0218-x

Schlüsselwörter

  • Alkohol
  • Kardiomyopathie
  • Ventrikuläre Dysfunktion
  • Herzinsuffizienz
  • Alkoholabusus

Keywords

  • Alcohol
  • Cardiomyopathy
  • Ventricular dysfunction
  • Heart failure
  • Alcohol abuse