Making Too Merry Triggers ‘Holiday Heart’

Hearts are light during the holidays  —  so light they may be more inclined to fibrillate.

Around Christmas and New Year’s, emergency departments brace for a rise in cases of “holiday heart syndrome,” or isolated incidents of atrial fibrillation in otherwise healthy people who simply eat and drink too much.

“It’s this combination of alcohol and overeating,” said Robert Glatter, MD, an emergency department physician at Lenox Hill Hospital in New York. “Patients get so full, and they start to get palpitations.”

Although it’s mainly attributed to alcohol, add to the mix caffeine, excessive amounts of food, and lack of sleep, and you have the perfect recipe for cardiac effects, Glatter noted.

Patients often come in describing the sensation that their heart is racing out of their chest, Rich O’Brien, MD, an emergency physician at Moses Taylor Hospital in Scranton, Pa., told MedPage Today.

Typically, they’re placed on an IV for hydration, and most rapid or irregular heartbeats resolve on their own. But when the heart persistently beats too fast – over 120 beats per minute – O’Brien says medication is needed to slow it down.

The drug of choice tends to be a beta-blocker or a calcium channel blocker such as verapamil or diltiazem. Only the most severe cases need cardioversion, O’Brien said.

The late cardiologist Philip Ettinger, MD, coined the term “holiday heart syndrome” in 1978 in a study of 24 patients who drank heavily and regularly, but also had a holiday or weekend binge before the study (Am Heart J 1978; 95: 555-562).

“We knew it was sort of a catchy title,” Allen Weisse, MD, a retired professor of medicine at New Jersey Medical School in Newark, who was a co-author on Ettinger’s paper, told MedPage Today. “But we didn’t think it would become so universally recognized.”

“If Phil were alive today,” Weisse added, “he’d be gratified knowing that everyone knows about the condition.”

Ettinger found that the most common arrhythmia from all the excess alcohol was a supraventricular tachyarrhythmia that resolved after the liquor had cleared the patient’s body.

Since the condition tends to occur in people who are otherwise healthy, the exact mechanism by which it works isn’t clear. It could be due to alcohol’s tendency to heighten epinephrine and norepinephrine levels and sympathetic output.

Or it could have something to do with alcohol’s effects on electrolytes, particularly sodium, which plays a key role in heart rhythm, researchers said.

O’Brien noted that in rare instances, holiday heart syndrome can take a more serious turn when it poses the potential for a stroke. If the episode of atrial fibrillation persists, more blood pools in the heart’s upper chambers, increasing the risk of clotting.

If the clot makes its way out of the heart and into the brain, it can cut off the blood supply and lead to stroke, although O’Brien cautioned that this is relatively uncommon.

“These are healthy people to begin with,” he said, so their risk of problems beyond unusual sensations in their chest is exceedingly small.

Still, that’s no reason to overindulge, he warned. His advice: Stay away from the vodka and the energy drink Red Bull, a combination known for its ability to make patients feel strung out. The cocktail goes by several names including Speedball and Raging Bull.

And it’s not just Christmas or New Year’s when emergency departments are vigilant for the condition. It’s any holiday or time period that is associated with hard partying, such as spring break, “when there’s lots of alcohol involved,” O’Brien said.

– By Kristina  Fiore, Staff Writer, MedPage Today

Kristina Fiore joined MedPage Today after earning a degree in science, health, and environmental reporting from NYU. She’s had bylines in newspapers and trade and consumer magazines including Newsday, ABC News, New Jersey Monthly, and Earth Magazine. At MedPage Today, she reports with a focus on diabetes, nutrition, and addiction medicine.


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