‘Tis the season of holiday parties, powered by fatty, salty hors d’oeuvres with plenty of booze to wash them down.
The combination can create what doctors call “holiday heart syndrome.” It’s a term coined in 1978 to describe the sudden increase of patients in emergency rooms during the holidays complaining of irregular heart rhythms known as atrial fibrillation of AFib.
AFib is a racing or irregular heartbeat that often feels like a “flutter or quiver” in the chest. The feeling can be accompanied by lightheadedness, shortness of breath, fatigue and even chest pain. Left untreated over the long term, Afib can lead to blood clots, stroke, heart failure and other heart-related complications.
While having existing heart disease makes one more vulnerable to holiday heart syndrome, the sudden onset of atrial fibrillation mostly strikes perfectly healthy people with no existing heart issues.
“As originally described, this condition was most often seen in patients without underlying heart disease,” said North Carolina cardiologist Dr. Kevin Campbell.
The link to alcohol
“It is thought that AFib in holiday heart syndrome is related to overindulgence of alcohol,” Campbell said, which can short circuit the heart’s electrical system, change electrolyte levels (or salts), in the blood and increase the release of stress hormones such as adrenaline and cortisol.”
Even moderate amounts of alcohol consumption appear to increase the risk of atrial fibrillation, said Stanford cardiac electrophysiologist Dr. Marco Perez, who is running 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 really big rise in atrial fibrillation.”
Add in the typical holiday stressors and a lack of proper sleep, and the combination can be a “perfect storm,” said cardiologist Dr. Stephen Sinatra, who has seen this happen over the years in his private practice.
Sometimes people don’t even realize that they are putting themselves at risk, Sinatra said.
“People who are not alcoholics would go from an office party, to a private party that night to having relatives over the next day, drinking in each scenario,” Sinatra said. “Over a short period of time you can call that binge drinking.”
Current dietary guidelines define moderate alcohol consumption as one drink a day for women and two drinks a day for men. In the United States a standard drink is 14 grams of pure alcohol; in the UK it’s 10 grams – both of equal about 1.5 ounces of spirits, 5 ounces of wine or 12 ounces of regular beer.
You can see how easy it would be to overindulge during the holidays, or even over weekends during the rest of the year. That’s showing up in the rise of “binge drinking;” the Centers for Disease Control and Prevention say over half of American men report binge drinking once a month; nearly a fourth do so five times a month, averaging eight drinks per binging session.
“About 60% of binge drinkers at one point will experience an atrial fibrillation episode,” said Perez.
“And we know people who are chronic alcohol abusers certainly do 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 who have 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.”
Preventing ‘holiday heart’
Tips for preventing holiday heart while still enjoying your holidays include being conscious of the amount of alcohol you are consuming during the event, and staying well hydrated. Alcohol is very dehydrating, as are many of the salty tidbits often served to munch on.
“Prevention involves moderation in alcohol and eating,” Campbell said. “Getting plenty of exercise and plenty of sleep. And try to avoid big family discussions until after the holidays in order to minimize stress.”
However, if at any point over the holidays (or even during the year) you have palpitations, shortness of breath, lightheadedness or feel your heart rate is too fast, you should be checked by a doctor, Gulati said. Science still doesn’t know enough about holiday heart to be sure that you won’t have a more serious event, such as a stroke.
“There may be people who present with a stroke to the emergency room and at that time doctors are dealing with the acute stroke,” Gulati said. “And we don’t have the information or good databases to say how many of those people were a classic binge drinker over the holidays. We just don’t know.”