Fortunately, only in susceptible individuals does more than about four drinks six days per week for five to ten years result in damage to the heart muscle. This condition is called alcoholic cardiomyopathy. (See the chapter Heart Failure for information regarding reversible temporary cardiac muscle dysfunction versus permanent damage.) With cardiomyopathy, the heart becomes dilated and the muscle becomes flabby. Dilated cardiomyopathy is an important cause of heart failure. This is a disease of unknown cause where the heart muscle becomes swollen and enlarged and heart failure becomes severe. Genetic predisposition and viral infections may play a role, but approximately one-third of all cases of dilated cardio-myopathy is caused by excessive alcohol consumption (see the chapter, Cardiomyopathy).
Three basic factors appear to enhance alcohol myo-cardial damage:
1. A direct toxic effect of alcohol or its metabolites acting on the muscle cells
2. Nutritional deficiency, particularly thiamine deficiency that is a cause for beriberi heart disease; alcoholic cardiomyopathy, however, has been shown to occur in the absence of nutritional deficiencies
3. Toxic effects due to additives in the alcoholic beverage or derived from containers in which the alcohol is stored

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