Dilatation of the left ventricle cavity and its contractility decrease with the subsequent heart failure development against the background of prolonged excessive alcohol consumption is commonly called alcoholic cardiomyopathy (ACM). The direct toxic effect of ethanol and its metabolites on the myocardium, neuroendocrine disorders, other manifestations of alcoholism and a genetic predisposition play a significant role in the development of this pathology. The purpose of this review is to study modern ideas about the mechanisms of development and course of ACM. In particular, special attention is paid to discussing the doses of alcohol necessary for the onset of symptoms and its regression. Actual data are presented in relation to a survey aimed at confirming alcohol abuse and the exclusion of alternative causes of myocardial injury, as well as treating patients and determining the prognosis. © 2019, Silicea-Poligraf. All rights reserved.