Alcohol Attacks the Liver but Spares the Heart

To the Editor.  —Alcohol can induce not only hepatic cirrhosis but also dilated cardiomyopathy. However, it is unusual to find both in the same patient.¹ When a cirrhotic patient develops an enlarged cardiac silhouette on the chest roentgenogram, the differential diagnosis between cardiac enlargement and pericardial effusion often poses a diagnostic challenge.² The article by Shah and Variyam³ in the March 1988 issue of the Archives pointed out another cause of secondary left ventricular dysfunction on the echocardiogram in cirrhotic patients with ascites, namely, pericardial effusion. Since resolution of ascites in their patients was associated with normalization of the left ventricular function, these patients did not have intrinsic myocardial dysfunction. Thus, the old adage that alcohol while attacking the liver spares the heart receives further scientific support.