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The effect of alcohol consumption on cardiac and cardiovascular functions remains a point of contention in the medical field. The consumption of low or moderate amounts of alcohol has been largely associated with having beneficial effect on cardiac contractility and the cardiovascular system as a whole, owing to the detected vasodilatory effect exerted by the alcohol, and the reduction in mortality documented by several studies. In contrast, excessive alcohol consumption results in negative outcomes in both men and women, with cardiac arrhythmias and atrial fibrillation, abnormality in cardiac contraction leading to heart failure, and dilated cardiomyopathy, and overall cardiovascular dysfunctions, including hypertension. The main points of contention are two-fold: the dose of alcohol at which its perceived beneficial effects disappear and proper cardiac and cardiovascular functions become progressively impaired, and how to clinical and therapeutically address cardiac and cardiovascular pathologies in chronic alcoholics to ameliorate their general conditions and their prognosis. The present review aims at providing the reader with a general understanding of the effects of alcohol on the cardiovascular system and the pathophysiological mechanisms that lead to the most common cases of cardiac dysfunction, and highlight the current guidelines for treatment of alcoholic cardiomyopathy to ameliorate clinical presentation and prognosis in alcoholic patients.