Primary myocardial disease and alcoholism. The clinical manifestations and course of the disease in a selected population of patients observed for three or more years.

The course of primary myocardial disease (PMD) was observed in 39 alcoholics. After initial examination 3 years or more before this report, we classified the severity of each patient's illness as stage I, II, or III. Stage I patients had minimal symptoms and normal-sized hearts. Stage II patients had evidence of concentric left ventricular hypertrophy and clinical manifestations like those of hypertensive heart disease. Stage III patients had left, and frequently right, ventricular hypertrophy and dilatation associated with persistent congestive heart failure, and clinical manifestations typical of patients with PMD. Only the duration of congestive heart failure differed significantly between stages II and III. Eight patients had exploratory mediastinotomy and myocardial biopsy. Gross and microscopic findings supported the diagnosis of PMD and our classification of severity and revealed diffuse interstitial fibrosis. Fifteen patients have been observed for 3 or more years; 10 have died and 14 have disappeared. These studies emphasize alcoholism's importance in the genesis of this form of PMD. Correlations were positive between abstention from alcohol and waning of clinical severity, and between persistent drinking and waxing of clinical severity.