What is Holiday Heart Syndrome?
Alcohol is commonly consumed in Western societies, and many people believe that drinking it moderately might be good for the heart. Despite this belief, too much alcohol can harm your heart’s health.
The phrase “holiday heart syndrome” (HHS) is used to talk about heart rhythm problems that show up after someone drinks too much alcohol in a short amount of time. This usually happens during weekends or holidays. The link between heart rhythm problems and heavy drinking was first noted by a researcher named Ettinger and his team. They found that 24 patients had to go to the hospital with a specific heart rhythm problem called atrial fibrillation after drinking a lot of alcohol over a weekend.
Further studies have shown that HHS can also happen in people who don’t often or never drink alcohol, but sometimes drink a lot at once.
What Causes Holiday Heart Syndrome?
About 40 years ago, researchers discovered that excessive drinking in short spans, often during weekends and holidays, was associated with irregular heartbeats, also known as atrial fibrillation. Since then, many more studies have delved deeper into this association between alcohol consumption and irregular heartbeats.
Most of these studies are based on people’s memory of their drinking habits, so there’s a chance that the data might be skewed due to inaccurate memories. To address this uncertainty, a different type of study was carried out. Instead of relying on participants’ memory, the study used wearable devices to monitor alcohol consumption in real time, and confirmed that sudden, heavy drinking can indeed trigger irregular heartbeats in people who are already prone to it.
In this real-time monitoring study, 100 participants were included. More than half of them experienced irregular heartbeat episodes. Over a period of four hours, participants who had two or more drinks were roughly 3.6 times more likely to experience an episode of irregular heartbeat. Even those who had just one drink doubled their risk of having an episode.
Additionally, by analyzing the alcohol level in their blood during the 12 hours before an irregular heartbeat episode, it was found that for every 0.1% increase in peak blood alcohol concentration, the chances of having an irregular heartbeat increased by 38%.
Risk Factors and Frequency for Holiday Heart Syndrome
Drinking alcohol is common in Western countries, with over half of Americans regularly having a drink. Furthermore, 44% of these drinkers – around 61 million people – engage in binge drinking. Binge drinking is when someone consumes five or more standard drinks in one go. The holiday season, from Thanksgiving to New Year’s Day, is a particularly popular time for alcohol sales, accounting for about a quarter of total sales each year.
‘Holiday heart syndrome’ is commonly seen in emergency departments. This condition, which often involves an irregular heartbeat known as atrial fibrillation, can be triggered by alcohol. In fact, between 35% and 62% of atrial fibrillation cases are due to alcohol, especially occurring 12 to 36 hours after a binge drinking session ends. Unfortunately, binge drinking is becoming more common among younger adults, which could lead to an increased number of atrial fibrillation cases in this age group.
Signs and Symptoms of Holiday Heart Syndrome
Holiday heart syndrome is a condition often seen in people who consume a lot of alcohol over short periods, like on weekends, vacations, and holidays. This syndrome usually leads to an irregular heartbeat, also known as atrial fibrillation. The primary symptom of this condition is palpitations, commonly known as heart palpitations. Heart palpitations can come and go or stay for longer periods, depending on whether the irregular heartbeat lasts and how the bottom chambers of the heart respond to the atrial fibrillation. If the bottom chambers respond quickly, the person might also feel tired out, weak overall, have chest pain, become breathless, or feel faint.
People who regularly drink alcohol over the long term might have additional health issues like chronic liver disease and a heart condition related to alcohol use. These health problems could affect their future health outcomes.
During a medical examination, people with holiday heart syndrome might show signs that they’ve had too much to drink. They might seem confused or slow to respond. Depending on their specific symptoms, their heart rate could be elevated, and their blood pressure might be low. Their pulse might feel weak and uneven. When the doctor listens to their heart, the beats might not follow a regular pattern. People with this condition who’ve chronically abused alcohol and developed dilated cardiomyopathy, another heart condition, might show signs of congestive heart failure. These signs could include high pressure in the neck veins, an extra heart sound, crackling sounds when the lungs are examined, swelling in the lower legs and ankles, and an enlarged liver.
Testing for Holiday Heart Syndrome
If you’re suspected of having alcoholism or heart-related problems, there are a number of medical tests your doctor may order to help diagnose and manage your condition.
Firstly, you might have to take a blood test that checks your potassium and magnesium levels, because low levels of these minerals are often seen in individuals with alcoholism. Substance like troponin and brain natriuretic peptides will also be checked in your blood to see if there’s any sign of heart damage or heart disease. In addition, a test that examines your red and white cells, known as a complete blood count, is helpful as people with alcohol problems are often low in these.
Patients who have a condition called atrial fibrillation, which is an irregular heartbeat, may require a form of medication that prevents blood clots to reduce the risk of stroke. The decision about this medication might depend on your blood levels and on your kidney and liver health.
A valuable tool in diagnosing heart conditions is the electrocardiogram, commonly known as an EKG. This test detects heart rhythm disorders like atrial fibrillation and can help identify if a fast heart rate is due to a serious condition like a heart attack or a blood clot in the lungs. Patients with heart rhythm disorders should have their heart rate continuously monitored to pick up any changes in their heart beat.
If you’re experiencing shortness of breath or showing signs of heart failure, a chest X-ray may be recommended. This can show if there’s fluid build-up in the lungs and can reveal if the heart is enlarged, which can happen in people with chronic alcoholism and rapid atrial fibrillation.
Another useful imaging test is called an echocardiogram, which provides a detailed picture of your heart’s size and shows how well it’s pumping. This test is essential to spot any sign of damage to your heart valves, chambers, and the muscular wall.
Overall, these tests provide critical information about your heart health, particularly if you’re a suspected alcoholic at risk of heart disease.
Treatment Options for Holiday Heart Syndrome
When patients come in with symptoms of alcohol intoxication or withdrawal, they’re often supported with a range of treatments. These could include intravenous fluids to hydrate the body, replacing important substances like electrolytes and vitamins (particularly thiamine and B-complex), and using a specialized protocol known as the Clinical Institute Withdrawal Assessment for Alcohol to manage withdrawal symptoms.
Patients who come to the emergency unit with irregularly fast heartbeats (tachyarrhythmias) are typically observed using continuous monitoring technology. In most cases, just keeping a close eye on the patient is enough.
However, if these irregular heartbeats lead to clinical instability – this could mean things like low blood pressure, confusion, signs of shock, chest pain, or acute heart failure – synchronized cardioversion may be needed. This is a procedure where an electric shock is used to restore a normal heart rhythm. The patient is sedated beforehand to make sure they’re comfortable and at ease.
For stable patients where the heartbeat irregularity is due to a condition called atrial fibrillation, treatment focuses on managing symptoms. This can be done through controlling the heart rate, ensuring a steady heart rhythm, and preventing blood clot formations that can cause stroke (thromboembolism prophylaxis). It’s worth noting that in more than 90% of cases, alcohol-induced atrial fibrillation tends to go away on its own 12 to 24 hours after the patient first shows symptoms.
A heart rate control strategy is employed for patients who are not clinically unstable. The aim here is to bring down the heart rate without causing low blood pressure. There isn’t an agreed optimal heart rate target, but a healthcare provider might recommend a heart rate of less than 85 beats per minute for a symptomatic patient. The target could be more flexible for patients showing no symptoms.
Doctors may use medications such as cardioselective beta-blockers or non-dihydropyridine calcium channel blockers to block the atrioventricular (AV) node, helping manage atrial fibrillation. Digoxin, another medication, is also an option but is rarely chosen. Long-term blood thinners could be used in atrial fibrillation to prevent stroke, but this should be considered carefully in patients with alcohol-related health problems.
Even though it’s believed that alcohol-induced atrial fibrillation tends to resolve itself, studies show that in about 20% to 30% cases, the condition may come back within a year. The most recent guidelines indicate that even if a condition is ‘reversible,’ it shouldn’t be a reason to avoid prescribing blood thinners for reducing stroke risk. The decision to start them should involve the patient’s participation and take into account their individual risk factors for both stroke and bleeding complications.
What else can Holiday Heart Syndrome be?
There are several conditions that can have similar symptoms and therefore need to be considered and ruled out by doctors. These include:
- Alcohol use disorder
- Arrhythmia (irregular heartbeat)
- Pulmonary embolism (a blood clot in the lungs)
- Community-acquired Pneumonia (lung infection caught outside of a hospital)
- Acute Coronary Syndrome (heart-related chest pain due to lack of blood flow to the heart)
- Dilated cardiomyopathy (a disease of the heart muscle)
- Thyrotoxicosis (high levels of thyroid hormone in the body)
- Substance abuse/drug abuse, particularly cocaine and amphetamines
Doctors will need to conduct particular tests and consider the patient’s medical history to correctly diagnose their condition and avoid confusion with these potentially similar conditions.
What to expect with Holiday Heart Syndrome
The outlook for holiday heart syndrome- a heart condition often caused by binge drinking- can vary greatly depending on if you have heart disease already. Similar to other diseases, long-term alcohol use raises the risk of abnormal heart rhythms, heart muscle disease, and chronic liver disease.
It’s worth mentioning that even though more than 90% of atrial fibrillation cases (a fast and irregular heartbeat) tied to alcohol resolve on their own, about 20% to 30% might come back within a year. When we consider different types of atrial fibrillation, moderate to heavy drinking shows up as the most common cause of progression from a type of atrial fibrillation that comes and goes, to a persistent type that requires treatment.
Possible Complications When Diagnosed with Holiday Heart Syndrome
Holiday heart syndrome can bring about different health problems such as:
- Severe heart rhythm disorders
- Constant and long-term atrial fibrillation, an irregular and often rapid heart rate
- The occurrence of dilated cardiomyopathy, a disease of the heart muscle, and congestive heart failure, a condition when your heart can’t pump enough blood to meet your body’s needs
- Blood clot-related stroke and the condition of having a blood clot traveling through the bloodstream
- Getting pneumonia from external sources, such as being out in the community
- Potential death
Preventing Holiday Heart Syndrome
People who have had a bout of alcohol-related heart rhythm disorder should stay away from any hard physical activities. Sometimes, too much adrenaline can cause the problem to happen again. However, if one doesn’t have any known heart disease (as shown through normal heart tests, like an electrocardiogram and echocardiogram), they can usually start doing their regular physical activities again after a few days.
One should know that there isn’t any known “safe” amount of alcohol that can stop one from getting a type of heart rhythm disorder known as atrial fibrillation. As a general rule, it is recommended to avoid drinking alcohol, especially since doing so can increase one’s risks of atrial fibrillation.
For those who may be finding it hard to stop drinking alcohol, there are medications and other non-drug sources of help available. Referrals can be made to clinics that counsel people on how to fight addiction, and local support groups, like Alcoholics Anonymous, can be extremely beneficial.
