Is It Safe to Drink Alcohol With Obstructive Hypertrophic Cardiomyopathy?

But for people already living with obstructive hypertrophic cardiomyopathy (oHCM), additional underlying factors and risks further complicate the potential effects of alcohol.

If you have oHCM, can you still enjoy an occasional beer, cocktail, or glass of wine without putting extra stress on your heart?

How Obstructive Hypertrophic Cardiomyopathy Affects the Heart

Hypertrophic cardiomyopathy causes the heart muscle to become abnormally thick. In the obstructive form of the disease, that thickened muscle narrows the path blood takes out of the left ventricle, the heart’s main pumping chamber. The obstruction can make it harder for blood to leave the heart and contribute to symptoms such as chest pain, shortness of breath, dizziness, and fainting.

With oHCM, the degree of obstruction can change depending on what’s happening in the body. Lower blood pressure or less blood returning to the heart can increase that obstruction, says Jack O’Sullivan, MD, a cardiologist at Stanford Health Care in California.

How Alcohol Can Affect the oHCM Heart

Alcohol can affect several factors that are particularly important when you have oHCM, says Milind Desai, MD, a cardiologist and the director of the HCM Center in the Heart Vascular Thoracic Institute at Cleveland Clinic in Ohio.

Dehydration and Lower Blood Pressure Alcohol can contribute to dehydration and widen blood vessels, which lowers blood pressure. Both changes can worsen the obstruction and increase the chance of dizziness or fainting, says Dr. Desai.

Faster or Irregular Heart Rhythms Alcohol can increase heart rate and may trigger abnormal rhythms, particularly atrial fibrillation, says Desai. “Some people notice palpitations, lightheadedness, chest discomfort, or shortness of breath even with small amounts of alcohol,” he says.

A Combination of Problems With Heavier Drinking “Heavier drinking, binge drinking, or drinking in hot weather or after exercise is especially concerning, because it can combine dehydration, vasodilation, and rhythm triggers,” says Desai.

These factors can also reduce the amount of blood returning to the heart and make it harder for blood to leave the heart, says Dr. O’Sullivan.

But the evidence specific to alcohol and oHCM is limited; the abovementioned study tested only one amount of alcohol, and there are no long-term trials or cohort studies showing how different drinking levels affect people with oHCM, says O’Sullivan.

“The evidence is not as strong or specific as many patients would like, but the caution is medically reasonable,” says Desai.

Alcohol and Interactions With HCM Medications

“Alcohol may interact directly or indirectly with some medications taken by people with oHCM,” says Desai.

Alcohol can add to the effect of several medications used in oHCM and potentially increase lightheadedness or fainting, says O’Sullivan. These drugs include:

• Beta-blockers, such as metoprolol and atenolol
• Calcium channel blockers, such as verapamil and diltiazem
• Disopyramide, an antiarrhythmic medication

“Other medications, including diuretics, anticoagulants, and antiarrhythmics, also warrant an individual discussion about alcohol,” he says.

“There isn’t a classic major alcohol interaction with the cardiac myosin inhibitors [a new class of medication used to treat HCM] mavacamten (Camzyos) or aficamten (Myqorzo),” says Desai. “But because these drugs affect how strongly the heart contracts, it’s a good idea to check in with your cardiologist about drinking while taking those medications, particularly if you have symptoms or don’t tolerate alcohol well,” he says.

“Alcohol can also make it harder to tell whether symptoms are from the condition, the medication, or the alcohol itself,” says Desai.

How to Know How Much Alcohol, if Any, Is Okay

Alcohol isn’t automatically off-limits for everyone with oHCM, though heavy and binge drinking should be avoided, says Desai.

“Even moderate drinking (generally no more than one drink a day for women and one to two for men) may be poorly tolerated in some people with oHCM,” he says.

There is no oHCM-specific amount of alcohol that research has established as safe, agrees O’Sullivan.

Desai and O’Sullivan say people should be especially cautious about drinking alcohol, or consider avoiding it, if they have:

• A history of atrial fibrillation or another significant heart rhythm problem
• Fainting or near-fainting, low blood pressure, or frequent lightheadedness
• Significant chest pain, shortness of breath, or other oHCM symptoms
• Significant symptomatic obstruction or reduced heart pumping function
• Palpitations or other symptoms that have been triggered by alcohol before
• Medications that may increase the risk of low blood pressure

“Recent procedures or an unstable clinical condition may also be reasons to avoid alcohol, depending on your cardiologist’s advice,” says Desai.

Rather than trying to apply a general drinking limit to yourself, Desai suggests asking your cardiologist a more useful question: “Given my obstruction, symptoms, rhythm history, and medications, do you recommend avoiding alcohol entirely, or is occasional limited drinking acceptable?”

Practical Tips if You Choose to Drink

If your cardiologist says occasional alcohol is reasonable, O’Sullivan recommends taking a few precautions.

Stay well hydrated. Avoid alcohol when dehydration is more likely, such as during hot weather, illness, or after strenuous exercise.

Avoid binge or rapid drinking. Drink slowly and with food.

Consider your medications. Be particularly cautious if you take a medication that lowers blood pressure, such as a beta-blocker, calcium channel blocker, or disopyramide.

Pay attention to how you feel. Stop drinking and seek medical care for chest pain, new or worsening shortness of breath, lightheadedness or near-fainting, or a rapid or irregular heartbeat.

Some symptoms warrant urgent medical attention whether or not they happen after drinking, says Desai. Fainting, severe chest pain or shortness of breath, a sustained rapid heartbeat, a shock from an implanted cardioverter-defibrillator (ICD), or possible stroke symptoms such as facial drooping, weakness, or trouble speaking, warrant urgent or emergency attention, he says.