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'Tis the season of giving and receiving, holiday gatherings and overindulgences. The combination can create what Dr. Philip Ettinger described as "Holiday heart syndrome" (HHS) for the first time in 1978.
It's one explanation for the sudden increase in emergency room visits during the holidays due to irregular heart rhythms and often more severe cardiac distress.
"Holiday heart syndrome," also known as alcohol-induced atrial arrhythmia, is associated with heavy alcohol consumption, especially binge drinking. While existing heart disease makes one more vulnerable, the sudden onset of AFib strikes perfectly healthy people with no evidence of heart issues.
The name is derived from the fact that episodes were initially observed more frequently after weekends or public holidays. Since Dr. Ettinger's first mention, 42 years have passed, and new research has brought some new awareness. "As originally described, this condition was most often seen in patients without underlying heart disease," said North Carolina cardiologist Dr. Kevin Campbell. "It is thought that AFib in holiday heart syndrome is related to the overindulgence of alcohol," Campbell said, which can short circuit the heart's electrical system, change electrolyte levels in the blood and increase the release of stress hormones such as adrenaline, and cortisol."
Some studies have shown that alcohol can have health benefits when consumed moderately, known as the "French paradox." Even moderate amounts of alcohol consumption appear to increase the risk of atrial fibrillation, said Stanford cardiac electrophysiologist Dr. Marco Perez, who had run the Apple Watch Heart trial on atrial fibrillation. "That risk is even higher with more severe amounts of alcohol consumption," Perez said. "Once you get into the three drinks or above category, you start seeing a considerable rise in atrial fibrillation."
Among its adverse cardiovascular effects, alcohol overconsumption can increase blood pressure, a risk factor for stroke and other cardiovascular diseases. There is also a higher risk of sudden cardiac death with alcohol abuse, which increases with the amount ingested, regardless of previous heart events such as myocardial infarction.
Moderate alcohol consumption is considered one drink/per day for women and two drinks/per day for men. One can see how easy it would be to overindulge during the holidays or even over weekends during the rest of the year. The Centers for Disease Control and Prevention report that over half of American men report binge drinking once a month; nearly a quarter do so five times a month, averaging eight drinks per binging session.
"And we know people who are chronic alcohol abusers have more arrhythmia, including atrial fibrillation," said cardiologist Dr. Martha Gulati, editor-in-chief of the American College of Cardiology's patient engagement initiative, called CardioSmart.
"And of course, if people have existing risk factors for heart disease or stroke, like obesity or high blood pressure, their risk of holiday heart goes way up," Gulati said.
"I certainly tell my patients with hypertension to be careful with alcohol because alcohol can raise your blood pressure," Gulati said. "And certainly, we know hypertension is one of the risk factors that can increase your risk for atrial fibrillation." If diagnosed early and treated with alcohol cessation, the prognosis for holiday heart disease is good. The previous thinking was that complete alcohol cessation was needed to see a reversal of the disease process.
Recent studies have shown that reducing consumption to less than 80 mg daily may aid reversible cardiac changes. If left untreated, it may culminate in severe cardiomyopathy (weakening the heart muscle with resultant congestive heart failure) and, ultimately death.
Don’t forget the stress that the holidays place on many of us.
“My sage advice and there is no medicine in it, is that it is better to simplify and emphasize family and friends rather than trying to create the perfect Norman Rockwell holiday,” said Dr. Pack.
Stress leads to anxiety and the release of epinephrine into the blood system, sometimes contributing to a rapid or irregular heartbeat.
Studies have shown that not only are the winter holidays associated with heart problems, but when they do happen, they are more likely to be fatal. According to a 2004 study published in the journal Circulation, researchers discovered increases of 5% more heart-related deaths during the holiday season.
For many, the holidays mean it's cold outside, which can be hard on the heart and put extra strain on it.
“What happens is that your arteries tend to tighten up when you are out in the cold, and your blood pressure goes up, which can overload your heart, possibly leading to a heart attack. If you have previously suffered a heart attack or have heart disease, you should avoid shoveling snow and other outdoor exertion, particularly if you are out of shape and haven’t been exercising regularly. Let someone else do it, like a nephew or neighbor. And be sure to bundle up when going out into the cold,” said Dr. Quinn Pack, a preventive cardiologist in Boston at the Baystate Medical Center.
He added that while combining cold weather and shoveling can increase one’s chances of having a heart attack; the likelihood is about 1 in 100,000 people, still a small chance.
“We do see three to five extra heart attack victims in our cardiac intensive care unit after each snowstorm,” said Dr. Pack.
As for the cold weather, Dr. Pack said it’s not so much the day-to-day cold of the winter that poses a threat as much as a sudden shift in weather.
“Literature suggests that these sudden shifts, such as going from warm to cold in a very short time, puts extra stress on the heart leading to a possible heart attack,” he said. “But I like to put things into perspective. These are small risks compared to smoking, diabetes, hypertension, being overweight and physical inactivity in the colder months all place on your chances of developing coronary artery disease.”
Tips for preventing HHS are pretty straightforward: Moderation and observation. Stay hydrated, since alcohol can dehydrate us very quickly, and get plenty of exercise and sleep.
Try to minimize family stress, too; consider avoiding significant family discussions until after the holidays.
Most importantly, if you experience a racing heart and develop shortness of breath or lightheadedness - during the holidays or any time during the year - make sure to see your doctor.
Seek more urgent treatment if appropriate. Science still doesn't know enough about holiday hearts to be sure that you won't have a more serious event, such as a stroke, so err on the side of caution.
"There may be people who present with a stroke to the emergency room, and at that time, doctors are dealing with the acute stroke," Dr. Gulati continued. "And we don't have the information or good databases to say how many of those people were classic binge drinkers over the holidays. We just don't know."
As with so much in life, moderation will go a long way.
Have a safe, joyous, and healthy holiday season and a very happy new year -
from all of us in Suite 1401
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The study: Brown KN, Yelamanchili VS, Goel A. Holiday Heart Syndrome. [Updated 2020 Aug 16]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: Holiday Heart Syndrome - StatPearls - NCBI Bookshelf
