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Holiday Heart Syndrome

Holiday heart syndrome is a clinical entity characterized by the development of cardiac arrhythmias associated with binge drinking and excessive alcohol consumption. The condition is transient and resolves spontaneously after abstinence from alcohol. The diagnosis can be made only after confirming a recent history of heavy alcohol drinking while physical examination and electrocardiography are used to diagnose cardiac arrhythmias.


Presentation

Holiday heart syndrome (HHS) was initially described in the late 1970s in individuals who consumed excessive amounts of alcohol during the holiday seasons and weekends (either on a regular basis or "binge" drinkers) and developed various forms of cardiac arrhythmias [1] [2] [3]. Scarce reports exist on the topic, but studies have determined that individuals who consume > 60 grams (or even > 36 grams) of pure ethanol/day are at a significant risk for atrial fibrillation (AF), the principal arrhythmia seen in patients with HHS [2] [4] [5]. The exact pathogenesis remains to be elucidated, but sudden intake of large amounts of alcohol seems to reduce the refractory period of the right atrium, impair vagal tone and promote conduction blocks [4]. When AF is present, patients can complain of dyspnea, palpitations, presyncope, weakness, light-headedness and fatigue [6]. In some individuals, an association between alcohol consumption and heart failure has been made, which is supported by the confirmed ability of alcohol to induce oxidative stress, electrolyte imbalance, scarring of the cardiac tissue and a negative inotropic effect by disrupting the activity of calcium channels [4] [5]. Heart failure, however, is more commonly related to chronic alcohol abuse, whereas HHS is an acute deterioration resulting from excessive amount of intake over a short period of time.

Heart Disease
  • Although many of the patients have underlying heart disease, there are reports of patients with no evident heart disease where acute alcohol injestion has caused arrhythmias.[ncbi.nlm.nih.gov]
  • The holiday heart syndrome should be considered particularly as a diagnosis in patients without overt heart disease presenting with new onset atrial fibrillation.[ncbi.nlm.nih.gov]
  • In 1978, Philip Ettinger described "Holiday heart syndrome" (HHS) for the first time, as the occurrence, in healthy people without heart disease known to cause arrhythmia, of an acute cardiac rhythm disturbance, most frequently atrial fibrillation, after[ncbi.nlm.nih.gov]
  • Keywords: Holiday Heart Syndrome, alcohol misuse, coronary heart disease, alcohol cessation, arrhythmias[ajol.info]
  • If you have previously suffered a heart attack or have heart disease, you should avoid shoveling snow and other types of outdoor exertion, particularly if you are out of shape and haven’t been exercising regularly.[healthcarenews.com]

Workup

As HHS is a syndrome related to binge drinking during the holidays or weekends, a detailed patient history is essential to point towards the diagnosis. A recent history of consumption of large amounts of alcohol or attending some events or celebrations can provide an inital clue, while physical examination can confirm alcohol intoxication and arrhythmias. Alcohol in the patient's breath and irregular pulses may be often encountered [6]. A heterogeneous anamnesis from friends or family members is favorable if the patient is not competent to provide adequate data, or if patients deny alcohol consumption. If signs of cardiac conduction abnormalities are present, electrocardiography (ECG) should be performed promptly. Typical findings of Atrial Fibrillation(AF) on ECG are absence of P waves, irregular R-R intervals and QRS complexes with fibrillatory (f) waves appearing at rates as high as > 300/min) [6]. If AF is confirmed, cardiac ultrasonography is recommended, in order to assess the entire cardiac apparatus and determine whether additional abnormalities, such as scarring, atrial or ventricular dysfunction, and other signs of myocardial injury are present. Assessment of serum electrolyte levels (especially potassium levels) and thyroid hormone levels are recommended in the initial workup as well [6].

Ventricular Repolarization Abnormalities
  • Although ventricular repolarization abnormalities on surface ECG were described, whether ventricular myocardium responds similarly to ethanol is uncertain.[emedicine.com]

Treatment

  • All content of this newsletter is intended for general information purposes only and is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment.[flushinghospital.org]
  • Medication and cardioversion are the main treatment options for holiday heart syndrome.[healthhype.com]
  • Find out the causes for it and what treatment a patient should receive. Joni Dirks is a critical care educator at Sacred Heart Medical Center in Spokane, Wash. Excessive alcohol intake can cause dysrhythmias.[journals.lww.com]
  • Although AFib is a common condition, there is not a one-size-fits-all treatment.[news.med.virginia.edu]

Prognosis

  • Prognosis The prognosis of holiday heart syndrome (HHS) depends on the presence of any underlying heart disease. Long-term alcohol use increases the risk of cardiomyopathy, arrhythmia, and chronic liver disease.[emedicine.com]

Epidemiology

  • ., Associate Professor, Unit of Nutritional Epidemiology, Institute of Environmental Medicine at the Karolinska Institutet in Stockholm, was lead author of the study.[drugabuse.com]
  • American Journal of Epidemiology, 124(3), 481-489. 5 Laposata, E.A. & Lange, L.G. (1986). Presence of nonoxidative ethanol metabolism in human organs commonly damaged by ethanol abuse.[blog.virtualability.org]
  • Epidemiology United States data The frequency with which cardiac arrhythmias can be attributed to alcohol use is unclear owing to differing data.[emedicine.com]
Sex distribution
Age distribution

Pathophysiology

  • […] of marijuana may have corresponding effects. [6] The most common rhythm disorder with HHS is atrial fibrillation. [7, 8] HHS should be considered as a diagnosis in patients without structural heart disease and with new-onset atrial fibrillation. [9] Pathophysiology[emedicine.com]

Prevention

  • Patient Services Medical Center Physicians Group Claude Moore Library School of Nursing School of Medicine UVA A Blog About UVA and Your Healthcare People of UVA Prevention Kids Patient Stories General Health News Recipes Search for: Club Red has joined[clubreduva.com]
  • Kloner, MD, PhD, a professor at the Keck School of Medicine at the University of Southern California, on how to prevent falling victim to the holiday heart syndrome.[asiaone.com]
  • How Can Holiday Heart Syndrome Be Prevented? As with most heart-related complications, moderation is the key whether in eating and undertaking physical activities, such as shoveling snow.[techtimes.com]
  • There are some things doctors recommend to prevent heart problems this holiday season. Try to limit foods high in sodium, fats and sugar, stay active and de-stress, especially if you've already had a heart attack.[wcyb.com]

References

Article

  1. Ettinger PO, Wu CF, De La Cruz C Jr, et al. Arrhythmias and the "Holiday Heart": alcohol-associated cardiac rhythm disorders. Am Heart J. 1978;95(5):555-562.
  2. Samokhvalov AV, Irving HM, Rehm J. Alcohol Consumption as a Risk Factor for Atrial Fibrillation: a Systematic Review and Meta-Analysis. Eur J Cardiovasc Prev Rehabil. 2010;17(6):706-712.
  3. Gronroos NN, Alonso A. Diet and Risk of Atrial Fibrillation: Epidemiologic and Clinical Evidence. Circ J. 2010;74(10):2029-2038.
  4. Liang Y, Mente A, Yusuf S, et al. Alcohol consumption and the risk of incident atrial fibrillation among people with cardiovascular disease. CMAJ. 2012;184(16):E857-866.
  5. Tonelo D, Providência R, Gonçalves L. Holiday Heart Syndrome Revisited after 34 Years. Arq Bras Cardiol. 2013;101(2):183-189.
  6. Porter RS, Kaplan JL. Merck Manual of Diagnosis and Therapy. 19th Edition. Merck Sharp & Dohme Corp. Whitehouse Station, N.J; 2011.

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Last updated: 2019-07-11 20:48