The focus of this review is on the effects of alcohol on the myocardium and its role as a cause of heart failure due to dilated cardiomyopathy (DC). For nearly 150 years, alcohol consumption has been associated with a variety of cardiovascular diseases. Observations during the second half of the 19th century described cardiac enlargement seen at autopsy and heart failure symptoms in persons who had consumed excessive amounts of alcohol.
During the first half of the 20th century, the concept of beriberi heart disease (ie, thiamine deficiency) was present throughout the medical literature, and the idea that alcohol had any direct effect on the myocardium was doubted. Epidemics of heart failure in persons who had consumed beer contaminated with arsenic in the 1900s and cobalt in the 1960s also obscured the observation that alcohol could exhibit a direct toxic effect