As we all probably know well, the holidays are that wonderful time of year where we get to relax, eat, drink and be merry. Well it turns out that all of the eating, drinking, and stressing about being merry may be doing more harm than good. Why you ask? This little issue called holiday heart syndrome.
Holiday heart syndrome itself is characterized as an acute cardiac arrhythmia in otherwise healthy individuals after episodes of binge drinking (more than five alcoholic beverages in one sitting). The exact pathophysiology is not well understood about this syndrome, but most studies have based their hypotheses on what we know about alcohol.
Alcohol effects our body in a few ways. Firstly, alcohol is broken down in the liver into something called acetaldehyde. This then, through a very interesting biochemical pathway, ends up causing a disturbance in calcium transport to our cardiac cells. And as we know from our physiology lectures, we need both intracellular and extracellular calcium in order for cardiac cells to contract properly. So more acetaldehyde, more irregular calcium transport, less properly functioning cardiac cells, then we do not get an action potential in the pacemaker cells.
Next, we know that consuming more than 2 grams of alcohol per liter per day inhibits cardiac sodium ion channels. This could then lead to increased activity of the sodium/calcium exchange within the cell resulting in prolonged action potentials. This later would result in slowing of electrical conduction from the atrium to the ventricles, leading to an arrhythmia.
Lastly, alcohol has been found to increase sympathetic nervous system activity. This leads to increased blood pressure, increased heart rate, and increased chance of arrhythmia. When all of these things are put together in the presence of stress, lack of sleep, plenty of holiday junk food, and dehydration, there is a result of a holiday heart syndrome.
What do these patients complain of when the come into the clinic? The most common symptoms are palpitations or a "racing heart" sensation, shortness of breath, fatigue, or anxiety. When evaluated, most patients with this syndrome have normal laboratory studies but show an arrhythmia like atrial fibrillation or atrial flutter on an ECG.
So when we are all finally done with class and preparing for the holidays with our families, the moral of the story is eat healthily, drink a little, relax, sleep, and be merry.
Tonelo D, Providência R, Gonçalves L. Holiday heart syndrome revisited after 34 years. Arq Bras Cardiol. 2013 Aug;101(2):183-9. doi: 10.5935/abc.20130153. PMID: 24030078; PMCID: PMC3998158.
Hey Jenn (and new team member!) - interesting post, something I'm sure we both saw while working in the ED over the holiday season. In my brief research, I came across an interesting study performed at the 2015 Munich Oktoberfest that associated alcohol consumption with cardiac arrhythmias. Researchers measured the BAC and ECG of 3028 voluntary participants. The mean BAC was 0.85 ± 0.54 g/kg. For reference - in the US, standard BAC units are g/100mL and we would read this BAC as 0.085. A BAC of 0.08 is considered "legally intoxicated" in the US.
ReplyDeleteOf these 3028 participants, 30.5% had a cardiac arrhythmia on their ECG, usually in the form of sinus tachycardia. Researchers associated this with changes in cardiac vagal tone and autonomic imbalance as measured by reduced respiratory sinus arrhythmia (heart rate increases with inspiration and decreases with expiration) in individuals with elevated BAC. According to researchers, this autonomic imbalance predisposes individuals to the development of atrial fibrillation - relating back to 'Holiday Heart Syndrome'. It can be easy to forget how impactful alcohol consumption can be in both acute and chronic settings. As you suggested, everything in moderation!
Reference:
Brunner, S., Herbel, R., Drobesch, C., Peters, A., Massberg, S., Kääb, S., & Sinner, M. F. (2017). Alcohol consumption, sinus tachycardia, and cardiac arrhythmias at the Munich Octoberfest: results from the Munich Beer Related Electrocardiogram Workup Study (MunichBREW). European heart journal, 38(27), 2100–2106. https://doi.org/10.1093/eurheartj/ehx156