Alcoholic dilated cardiomyopathy presents with which features?

• A. Hypertension with preserved EF and no alcohol use
• B. Normal EF with hypertension
• C. Systolic heart failure with reduced EF, history of alcohol use with thin walls
• D. Diastolic heart failure with preserved EF

Answer: (C)

Alcoholic dilated cardiomyopathy occurs when chronic heavy alcohol use directly damages the myocardium, causing dilation of the left ventricle and impaired contractile function. This leads to systolic heart failure with a reduced ejection fraction. The hallmark imaging finding is a dilated ventricle with thinning of the walls due to remodeling from weakened muscle, reflecting reduced stroke volume and systolic dysfunction.

So the description that best fits is a pattern of systolic heart failure with reduced EF in someone with a history of alcohol use, often with thin, dilated ventricular walls. Hypertension with preserved EF or diastolic dysfunction with preserved EF describes different forms of heart failure where systolic function is not reduced, or where alcohol isn’t the driving factor.