Doctor's Notes: Tips for Reducing Holiday Heart Syndrome

In 1987, holiday heart syndrome was described from a study of 24 patients who presented to the hospital during the holiday season with atrial fibrillation (afib), a rapid abnormal heart rhythm in the upper heart chambers that’s associated with symptoms of palpitations, shortness of breath, chest pain, lightheadedness, stroke, and heart failure. All 24 were relatively healthy. However, they 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 afib. Fortunately, this scenario is uncommon. However, when alcohol is toxic to the heart, it can be profound. 

I cared for an elderly patient who died long ago. He was a Catholic priest. Occasionally, he would drink alcohol, and about one or two days afterward he would be in the intensive care unit with severe heart failure and afib. 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 six 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 afib after heavy alcohol consumption, such as surges in the body’s adrenalin (sympathetic output), rises in the level of free fatty acids, 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 the Definition of Heavy Alcohol Intake?

According to the Substance Abuse and Mental Health Services Administration, part of the U.S. Department of Health and Human Services, “binge drinking for 5 or more of the past 30 days” is considered heavy alcohol use.

Right about now you may be asking, "I heard alcohol is healthy for the heart?" It is but in low to moderate amounts. At one or two drinks a day for women and one to three drinks for men, alcohol has a protective effect on 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 other risk factors for afib that are higher around the holidays as well. One of the most common problems is overeating. 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, which we use to digest food, rest, and sleep. When activated, this nervous system typically slows the heart rate. However, in people susceptible to afib, small areas in the upper chambers of the heart are triggered and actually begin to 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 too much of it, we can hold onto fluid, which causes blood pressure to rise. In people with a history of high blood pressure, heart valve problems, or heart failure, the increase in blood pressure and the higher amount of fluid in the body can stretch the upper heart chambers and cause afib to develop.

Finally, heart injury or heart attacks are much more likely around the holidays. In fact, deadly heart attacks most commonly occur on December 25 compared with all other days of the year. The second most common day is December 26 and the third, January 1. Possible explanations for why these heart attacks occur during the holidays include these reasons:

• Delaying regular check-ups or doctor’s appointment
• Cold weather
• Overeating
• Depression

Regarding afib, any heart injury, including a heart attack, can irritate the upper heart chambers and cause the abnormal heart rhythm to develop.


Tips to Prevent Holiday Heart Syndrome and Enjoy the Time of Year

• First, if you have any heart symptoms, go to the hospital early this holiday season, including the day of a holiday itself.
• Avoid heavy alcohol consumption.
• Avoid alcohol entirely if you have afib.
• Pace yourself when eating and step away from the table when full.
• Avoid adding salt to your diet. Most of the food we eat, particularly if processed, already has sufficient to excessive amounts of salt.
• 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.