Holiday Heart Syndrome

Dr. Prashant Prabhakar from Bahrain Specialist Hospital tells us more..

During the Thanksgiving, Christmas, and New Year’s season there are a lot of reasons to celebrate and enjoy the holiday spirit.  Unfortunately, it is often a time in which many people end up going to the Emergency Department for treatment of “Holiday Heart Syndrome”.

There was a song by LeAnn Rimes entitled “Put a little holiday in your heart”.  In this song, LeAnn sings “Put a little holiday in your heart, It’ll put a little shuffle in your step …”. Unfortunately, for those who end up in the Emergency Department, they had a little too much holiday in their heart.

What is Holiday Heart Syndrome?

In 1987, Holiday Heart Syndrome was described from a study of 24 patients that presented to the hospital during the holiday season with atrial fibrillation.  Atrial fibrillation is a very rapid abnormal heart rhythm in the upper heart chambers that is associated with symptoms of palpitations, shortness of breath, chest pain, lightheadedness, stroke and heart failure.  These 24 patients were all relatively healthy.  However, the patients shared one thing in common, they drank alcohol heavily or regularly and then went on a binge during the holiday season.

Why does Heavy Alcohol Consumption Cause Holiday Heart Syndrome?

The honest answer is we don’t fully know.  There is some evidence that alcohol consumption is cardiotoxic.  In susceptible individuals, the heart muscle can be severely weakened when exposed to alcohol.  When the heart muscle weakens, the heart pressures increase, and the upper chambers stretch and develop atrial fibrillation.  Fortunately this type of scenario is uncommon.  However, when alcohol is toxic to the heart it can be profound.  I cared for an elderly patient that long ago died.  He was a Catholic priest.  Occasionally he would drink alcohol and about 1-2 days after he would be in the intensive care unit with severe heart failure and atrial fibrillation.  We would give his heart an electrical shock to restore a normal heart rhythm and then start medications to heal the heart and support the blood pressure.  In a few weeks, and without any exposure to alcohol, his heart function was back to normal.  He would do well for 6 months and then he would drink alcohol again and restart the process.  When I asked him why he drank knowing the consequences, he said he enjoyed wine too much to go a whole year without it.

There are other possible causes of atrial fibrillation after heavy alcohol consumption such as surges in the body’s adrenalin (sympathetic output), rises in the levels of free fatty acids, and alterations of the electrical currents of the heart through altering how sodium moves in and out of the heart cells, and lowering the levels of sodium, potassium, and magnesium in the body through diuresis.

What is Heavy Alcohol Intake?

Heavy alcohol intake in women is defined as consuming seven or more drinks per week or over three doses at one time.  For men, heavy consumption is defined as over fourteen drinks per week or over four drinks at one time (US Department of Health and Human Service).

You may be asking at this time, I heard alcohol is healthy for the heart?  It is, but in low to moderate amounts.  At low and moderate levels (1-2 drinks, ≤15 g/day for women and 1-3 drinks, ≤30 g/day for men) alcohol has a protective effect in the heart and is associated with lower levels of coronary artery disease, cerebral vascular disease, and peripheral vascular disease.

Does Alcohol Alone Explain Holiday Heart Syndrome?

There are also other risk factors for atrial fibrillation that are higher around the holidays.

One of the most common problems is over eating.  Eating a large amount of food at one sitting causes the stomach and bowels to stretch and distend to accommodate it.  This activates the nervous system in our body called the vagal or parasympathetic nervous system that we use to digest food, rest, and sleep.  This nervous system when activated typically slows the heart rate.  However, in people susceptible to atrial fibrillation, small areas in the upper chambers of the heart actually are triggered and beat very fast leading to the abnormal heart rhythm.  These areas often reside in the small veins that drain blood from the lungs into the left upper heart chamber.

Another common problem is salt consumption.  Our bodies need salt, but when we consume a lot of salt our bodies can hold onto fluid and our blood pressure can rise.  In people with a history of high blood pressure, heart valve problems, or heart failure, the increase in blood pressure and higher amount of fluid in the body stretches the upper heart chambers and atrial fibrillation develops.

Finally, heart injury or heart attacks are much more common on the Holidays.  In fact, deadly heart attacks most commonly occur on December 25th compared to all other days of the year.  The second most common day is December 26th and the third, January 1st.  Many possibilities have been raised to answer why these heart attacks occur during the holidays.  These include people waiting too long to receive care for their heart, the cold weather, in some people sadness, depression, or despair, and in others some of the eating problems outlined above.  Regarding atrial fibrillation, any heart injury, including a heart attack, can irritate the upper heart chambers and cause the abnormal heart rhythm to develop.

What to do?

First, if you have any heart symptoms go to the hospital early this holiday season, including the Holiday days.  Avoid heavy alcohol consumption.  Try to minimize eating large quantities of food at once.  Avoid adding salt to your diet, most of the time the food we eat, particularly if processed, already has sufficient to excessive.  Finally, if you know someone who is depressed, alone, or isolated during the Holiday season, reach out and cheer them up, it may be the best thing you do for their heart as well as yours.

Dr. Prashant Prabhakar
(Cardiology Consultant)
Bahrain Specialist Hospital