A 50-year-old man with chronic alcoholism was hospitalized for congestive heart failure. The left ventricular ejection fraction was 35%, and the heart appeared enlarged on radiographs. Myocardial biopsy was performed, and the biopsy specimen most likely showed

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Alcohol abuse causes a dilated cardiomyopathy, which presents nonspecific histologic findings, such as interstitial fibrosis and hypertrophy of cardiac myocytes. These changes are a consequence of injury of cardiac myocytes caused by alcohol or thiamine deficiency. Damaged cells are replaced with foci of fibrous tissue, accounting for the interstitial fibrosis, whereas the remaining cardiac myocytes undergo compensatory hypertrophy.

A 50-Year-Old Man with Chronic Alcoholism Was Hospitalized for Congestive