The association between chronic alcohol consumption and alcoholic heart disease in human beings is well recognized. Chronic alcohol consumption is the leading cause of secondary cardiomyopathy, a heart muscle disease associated with long-term alcohol consumption. Both acute and chronic alcohol consumption have a negative inotropic effect on the myocardium, precipitate arrhythmias, and may provoke angina pectoris. There are numerous reports that alcohol changes many subcellular processes that are involved in excitation-contraction coupling. However, the exact mechanism(s) underlying these changes in the heart are still poorly understood. Despite the recent presumptive protective reports that moderate alcohol consumption protects against the risk of coronary artery disease, nurses and physicians must educate all patients about the many other adverse effects of alcohol on the cardiovascular system. The purpose of this article is to review and discuss the mechanism(s) that may underlie changes in contractile function after long-term alcohol consumption and identify current trends in identification and treatment of alcoholic heart disease.