Alcoholic cardiomyopathy is a severe consequence of chronic alcohol abuse and is a form of dilated cardiomyopathy. Current research into the pathogenesis of this condition has refined our understanding of the direct and indirect toxic effects of alcohol on the heart. Epidemiological studies attribute a significant role to alcohol abuse as a cardiovascular risk factor while clinical reports have established that alcoholic cardiomyopathy results in increased morbidity and mortality. Initially a clinically silent condition that can be detected by echocardiographic and electrocardiographic abnormalities, alcoholic cardiomyopathy slowly progresses to overt low-output heart failure. Abstinence is beneficial and can determine the reversal of cardiac impairment with a positive impact on prognosis. Specific diagnostic criteria are not yet available and differentiating alcoholic cardiomyopathy from other forms of cardiovascular dysfunction such as cirrhotic cardiomyopathy is challenging.