Holiday heart syndrome

Short description: Alcohol-associated arrhythmia condition

Holiday heart syndrome

Electrocardiographic image depicting atrial fibrillation (top, red arrow) and normal heart rhythm (bottom)
Specialty| Cardiology
Symptoms| Arrhythmia
Complications| Mitochondrial dysfunction, valvular heart disease, oxidative damage, cell death, dilated cardiomyopathy, electrical vulnerability of the atrium, thrombosis, pneumonia, Cirrhosis, heart failure, and potentially death
Usual onset| Usually following heavy amounts of Alcohol consumption
Duration| Usually 24 hours
Causes| High amounts of ethanol consumption
Risk factors| Drinking large quantities of alcohol, dehydration, high levels of stress
Diagnostic method| Blood tests and Medical imaging
Differential diagnosis| Alcohol use disorder, Dilated cardiomyopathy, Cirrhosis, Arrhythmia, Psychiatric disorders
Treatment| Cardioversion
Prognosis| If left untreated can have severe complications, and is possibly fatal
Frequency| Unclear

Holiday heart syndrome, also known as alcohol-induced atrial arrhythmias, is a syndrome defined by an irregular heartbeat and palpitations[1] associated with high levels of ethanol consumption.[2] Holiday heart syndrome was discovered in 1978 when Philip Ettinger discovered the connection between arrhythmia and alcohol consumption.[3] It received its common name as it is associated with the binge drinking common during the holidays.[4] It is unclear how common this syndrome is. 5-10% of cases of atrial fibrillation may be related to this condition, but it could be as high as 63%.[5]

## Contents

* 1 Etiology
* 2 Symptoms and complications
* 3 See also
* 4 References
* 5 Further reading
* 6 External links

## Etiology

Cardiologists are unsure exactly what causes holiday heart syndrome. The ingestion of alcohol may slow down the cardiac conduction system, which is an important system for managing the circulatory system. It may also shorten the refractory period of the atrium. Another possibility is that alcohol consumption increases the level of catecholamines, which increased the level of P-waves, and therefore the risk of arrhythmia. Alcohol intake can also lead to a rise in plasma free fatty acids and an increase in the activity of the sympathetic nervous system.[6][7] An ATP2A2 enhancer known as JNK2 may play a role. Alcohol may activate it, which can affect other proteins therefore increasing the risk of arrhythmia.[8] Heavy consumption of alcohol may lead to an increased level of ethanol and metabolites such as acetaldehyde inside of the body.[9][10] All of these factors can contribute to arrhythmia.[11]

Drinking large quantities of alcohol or caffeine,[12][13][14] eating fatty foods with salt,[15] heightened levels of stress,[16][17] and dehydration are all risk factors for the development of this syndrome. HHS can appear in people who do not usually drink. Often these people who rarely drink may engage in an episode of heavy alcohol consumption and develop it as soon as they drink, others contract it 12–36 hours following the time of intoxication.[18] Usually patients with this disorder lack any family history or previous clinical evidence of cardiological problems.[4] Studies suggest moderate drinking (5-7 drinks per week) may not increase the risk of atrial fibrillation compared to abstinence; however, consumption beyond this range is associated with a substantial increase in the risk of HHS, further supporting the greater risk that binge drinking poses to the development of this condition.[19]

## Symptoms and complications

The most common symptoms people with HHS have are heart palpitations and arrhythmia.[20] People usually present with atrial fibrillation; however, other forms of arrhythmia may be developed, such as atrial tachycardia, premature ventricular contraction, and atrial flutter. Patients with HHS also frequently report precordial pain, sweating, anxiety, shortness of breath, and syncope. Strokes and cardiac arrest can also occur in people with this syndrome.[4] People with holiday heart syndrome have a heightened risk of dilated cardiomyopathy, rhabdomyolysis, and acute kidney injury[21] and increased atrial vulnerability to external electrical stimulus under the influence.[22]

The heightened level of acetaldehyde this syndrome causes can result in mitochondrial dysfunction, valvular disease, oxidative damage, cell death, lowered effects of cardioprotective molecules, and an altered calcium transport and protein synthesis system.[4] If left untreated, it can result in thrombosis, pneumonia, cirrhosis, and heart failure.[5][18] For most patients with HHS the syndrome only lasts 24 hours. However for 26% of people with this syndrome, they reexperience an episode of it within the next year. To treat patients with this condition cardioversion or other treatments for arrhythmia are used.[4]

## See also

* Alcoholic cardiomyopathy

## References

1. ↑ Jain, Anubhav; Yelamanchili, Varun S.; Brown, Kristen N.; Goel, Akshay (2024), "Holiday Heart Syndrome", StatPearls (Treasure Island (FL): StatPearls Publishing), PMID 30725870, https://www.ncbi.nlm.nih.gov/books/NBK537185/, retrieved 2024-02-15
2. ↑ "Holiday Heart Syndrome: Background, Pathophysiology, Epidemiology". Medscape. 17 October 2021. https://emedicine.medscape.com/article/155050-overview.
3. ↑ "Arrhythmias and the "Holiday Heart": alcohol-associated cardiac rhythm disorders". American Heart Journal 95 (5): 555–562. May 1978. doi:10.1016/0002-8703(78)90296-x. PMID 636996.
4. ↑ 4.0 4.1 4.2 4.3 4.4 "Holiday heart syndrome revisited after 34 years". Arquivos Brasileiros de Cardiologia 101 (2): 183–189. August 2013. doi:10.5935/abc.20130153. PMID 24030078.
5. ↑ 5.0 5.1 "Holiday Heart Syndrome". StatPearls. Treasure Island (FL): StatPearls Publishing. 2022. https://www.ncbi.nlm.nih.gov/books/NBK537185/. Retrieved 2022-08-26.
6. ↑ "Impact of acute ethanol intake on cardiac autonomic regulation". Scientific Reports 11 (1). June 2021. doi:10.1038/s41598-021-92767-y. PMID 34168256. Bibcode: 2021NatSR..1113255B.
7. ↑ "Effects of alcohol on atrial fibrillation: myths and truths". Therapeutic Advances in Cardiovascular Disease 3 (1): 53–63. February 2009. doi:10.1177/1753944708096380. PMID 19124390.
8. ↑ "Role of Stress Kinase JNK in Binge Alcohol-Evoked Atrial Arrhythmia". Journal of the American College of Cardiology 71 (13): 1459–1470. April 2018. doi:10.1016/j.jacc.2018.01.060. PMID 29598867.
9. ↑ "Acute effects of alcohol on cardiac electrophysiology and arrhythmogenesis: Insights from multiscale in silico analyses" (in English). Journal of Molecular and Cellular Cardiology 146: 69–83. September 2020. doi:10.1016/j.yjmcc.2020.07.007. PMID 32710981.
10. ↑ "SR Ca2+-leak and disordered excitation-contraction coupling as the basis for arrhythmogenic and negative inotropic effects of acute ethanol exposure" (in English). Journal of Molecular and Cellular Cardiology 116: 81–90. March 2018. doi:10.1016/j.yjmcc.2018.02.002. PMID 29410242.
11. ↑ "Sudden atrial fibrillation associated with acute alcohol ingestion and cor triatriatum". Proceedings 22 (4): 335–336. October 2009. doi:10.1080/08998280.2009.11928550. PMID 19865505.
12. ↑ "Binge Alcohol Exposure Triggers Atrial Fibrillation Through T-Type Ca2+ Channel Upregulation via Protein Kinase C (PKC) / Glycogen Synthesis Kinase 3β (GSK3β) / Nuclear Factor of Activated T-Cells (NFAT) Signaling – An Experimental Account of Holiday Heart Syndrome". Circulation Journal 84 (11): 1931–1940. October 2020. doi:10.1253/circj.CJ-20-0288. PMID 33028764.
13. ↑ "HOLIDAY HEART SYNDROME: A Case Report". Medical Journal, Armed Forces India 52 (1): 61–62. January 1996. doi:10.1016/S0377-1237(17)30840-7. PMID 28769342.
14. ↑ "The Estimated Risk of Atrial Fibrillation Related to Alcohol Consumption". Journal of Atrial Fibrillation 5 (1): 424. 2012. doi:10.4022/jafib.424. PMID 28496744.
15. ↑ "Learn the symptoms of Holiday Heart Syndrome and how to prevent it." (in en). https://www.baystatehealth.org/news/2015/11/holiday-heart.
16. ↑ "'Holiday heart syndrome': What is it and how to avoid it" (in en). 2019-12-12. https://www.cnn.com/2019/12/12/health/holiday-heart-syndrome-wellness/index.html.
17. ↑ "Causal roles of stress kinase JNK2 in DNA methylation and binge alcohol withdrawal-evoked behavioral deficits". Pharmacological Research 164. February 2021. doi:10.1016/j.phrs.2020.105375. PMID 33316384.
18. ↑ 18.0 18.1 "Alcohol and Atrial Fibrillation: A Sobering Review". Journal of the American College of Cardiology 68 (23): 2567–2576. December 2016. doi:10.1016/j.jacc.2016.08.074. PMID 27931615.
19. ↑ Alvarado, Juan Daniel; Zuniga, Paola; Stringer, Immy; Ramirez, Allison; Cortes, Erick; Solano, Jhiamluka (February 2025). "Holiday Heart Syndrome: A Literature Review". Cureus 17 (2). doi:10.7759/cureus.79816. ISSN 2168-8184. PMID 40161046.
20. ↑ "What to Know About Holiday Heart Syndrome" (in en-US). 2021-12-03. https://health.clevelandclinic.org/can-avoid-holiday-heart-syndrome/.
21. ↑ "Acute Abdominal Aorta Thrombosis and Ischemic Rhabdomyolysis Secondary to Severe Alcohol Intoxication". Cureus 8 (12). December 2016. doi:10.7759/cureus.905. PMID 28083449.
22. ↑ "Effect of whiskey on atrial vulnerability and "holiday heart"". Journal of the American College of Cardiology 1 (3): 816–818. March 1983. doi:10.1016/S0735-1097(83)80195-8. PMID 6826972.

## Further reading

* "Alcohol and rhythm disturbance: the holiday heart syndrome". Herz 21 (4): 227–231. August 1996. PMID 8805002.
* "Antiarrhythmic drugs in patients with recurrent atrial fibrillation: where are we?". Italian Heart Journal 6 (3): 169–174. March 2005. PMID 15875505.

## External links

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