What is holiday heart syndrome?
Holiday heart syndrome is a term coined by a cardiologist, Philip Ettinger, M.D. to describe a cardiac condition associated mainly with excessive alcohol consumption coupled with overeating and possibly a lack of sleep. Despite the term, it does not not only occur on holidays although it is more common during the festive season, mainly Christmas and New Year’s. It is typically during these holidays that alcohol consumption increases excessively and often for prolonged periods as people indulge on consecutive days.
In holiday heart syndrome, there is dysfunction of the conduction system of the heart and irregular heart beat due to alcohol consumption in a person who does not have any history of heart disease. It is an acute condition that usually resolves spontaneously with abstaining from alcohol. However, most patients who develop holiday heart syndrome tend to have a history of heavy alcohol consumption on a regular basis. This does not mean that holiday heart syndrome cannot occur in people who usually consume alcohol in moderation but is less likely to be seen in these individuals.
How common is holiday heart?
The exact incidence of holiday heart syndrome is difficult to ascertain as not all patients seek medical treatment. Since the condition tends to resolve shortly after discontinuing alcohol use, incidents may never be reported. However, new-onset cases of arrhythmias, particularly atrial fibrillation, in patients younger than 65 years who were recently binge-drinking and often still inebriated at the time of seeking medical care may in fact be holiday heart syndrome in the majority of cases. Some studies have suggested that as many as 35% of cases of new-onset atrial fibrillation may be holiday heart syndrome. Males tend to be more frequently affected due to drinking habits rather than gender predilection.
Alcohol Effect on Heart Rhythm
The exact mechanism by which alcohol affects the normal rhythm of the beating heart is not clear. There are several theories as to the mechanism where alcohol or its metabolites can affect electrolyte levels, increase the stimulatory activity of the nervous supply to the heart, increase lipid levels in the bloodstream, alter the blood pH or directly irritate the heart muscle. Despite the uncertainty about the exact mechanism, it has been conclusively verified that alcohol does indeed cause disruptions in the rhythm of the heart.
This irregular heart rhythm is known as an arrhythmia. In holiday heart syndrome, it is a tachyarrhythmia where the abnormality in rhythm leads to an increased heart rate. Abnormalities in the heart’s electrical conduction system just above the ventricles contributes to this type of tachyarrhythmia in holiday heart syndrome. This is known as supraventricular tachyarrhythmia and the most common type seen in holiday heart syndrome is an atrial fibrillation. Other types of arrhythmias may also occur although less common.
With a disruption in the heart’s normal pattern of functioning, blood may pool in the heart. This can further exacerbate the heart problem. Blood pressure can drop and oxygen distribution throughout the body is impaired. There may also be an increased risk of clot formation. Subsequently these clots may dislodge from the heart and travel through the bloodstream to lodge elsewhere.
Holiday Heart Symptoms
There are a number of symptoms that are present with holiday heart syndrome. However, some patients tend to delay seeking medical care as it is the holiday season and at other times the symptoms may be misunderstood or ignored altogether as the patient is intoxicated. It is therefore important for the family and friends of the patient to note any possible symptoms and compel the person to seek medical attention.
- The most common symptom in holiday heart syndrome is palpitations where the person can feel the heart pounding hard.
- Less common or prominent symptoms include :
– Breathlessness with physical activity often passed off by the patient as being physically unfit.
– Cardiac chest pain due to ischemia (angina) which can sometimes be confused with heartburn or indigestion.
– Dizziness and the feeling that they are about to faint without collapsing sometimes passed off as fatigue or being intoxicated.
– Fainting spells which may sometimes be confused with passing out from alcohol intoxication.
– Irregular or thready pulse may be found on clinical examination.
Causes of Holiday Heart Syndrome
Holiday heart syndrome is mainly due to an excess of alcohol consumption. It is seen with binge drinking particularly over weekends and holidays. There is no pre-existing heart disease although in some instances there may be undiagnosed chronic diseases of the heart and liver. Concomitant recreational drug use, like cocaine, can worsen the condition. However, these patients tends to have a history of heavy drinking on a frequent basis and there may be a history of alcoholism. Even a moderate amount of alcohol intake can trigger holiday heart syndrome in some patients.
The combination of overeating and a lack of sleep during these periods may also contribute to holiday heart syndrome in conjunction with alcohol although the exact interplay of factors is not clear. The cardiac disturbance lies with the rhythm and sometimes the rate of the heart beat. Ultimately this affects the circulation of blood which impairs the oxygen supply to the body as does most heart diseases. Another major concern is that the irregular heart beats can lead to congestive heart failure or even a stroke although this is rare.
How much of alcohol is dangerous?
There is no definitive quantity that can induce holiday heart syndrome. Some studies have suggested that people who consume more than 6 drinks per day are at a greater risk of holiday heart syndrome than those who consume 1 drink per day. Men should consume a maximum of 3 units of alcohol per day while women should not exceed 2 units. Binge drinking should be avoided irrespective of the time of the year. Occasionally having an extra drink may not be harmful but holiday heart syndrome can occur in people who are moderate drinkers as well.
Holiday Heart Diagnosis
The symptoms should prompt a patient to seek medical attention. It may not always be as obvious and patients may not be able to clearly identify the symptoms in the backdrop of alcohol intoxication and overeating. Holiday heart syndrome is diagnosed with the use of an electrocardiogram (ECG) and if necessary, an echocardiograph should be conducted. These tests not only confirm the diagnosis but also identifies other pathological changes of the heart. Blood tests to monitor the electrolyte levels should also be conducted.
Treatment of Holiday Heart
Young patients with no observable heart disease may not require any specific treatment. The condition resolves on its own usually within 24 hours and the patient needs to be advised against excessive alcohol use. Constant monitoring during this time is important. However, if the arrhythmia is severe or persists for longer than 24 hours then medical intervention is necessary. Medication and cardioversion are the main treatment options for holiday heart syndrome.
- Anti-arrhythmic drugs, particularly AV node blockers, like beta-blockers (metoprolol) and calcium channel-blockers (verapamil and diltiazem) are the drugs of choice in severe cases.
- Electrical cardioversion is a procedure where electric shocks are delivered to the heart through electrodes placed on the chest. It may be necessary for arrhythmias persisting longer than 24 hours. Administration of anti-arrhythmic medication is a form of cardioversion with medication.
- Anticoagulants may be prescribed to prevent blood clots from forming in arrhythmias persisting for more than 48 hours. The risk is greater if cardioversion is continued for more than 48 hours.