Holiday Heart Syndrome: Too Much of a Good Thing

It's the Holiday Season -- a joyous, expressive time of the year.  It is the time of the year to enjoy family, friends, food, and good wine.  We all know that moderation is important in all things - it is important in this season as well.  I was reading an article from Medscape, a source that I trust and regard, and it affirmed for me the need to moderate in terms of eating and drinking.  I wanted to share an excerpt from the article with you, which discusses a well-established syndrome called Holiday Heart Syndrome.  Believe it or not, this condition was designated as a syndrome in 1978.

I realize this is an interesting article that most of us don’t need to read in order to be healthy through the season, yet perhaps it is important information to help us take care of those around us.  Here’s the excerpt:

“The ACEP (American College of Emergency Physicians) warns consumers about the risks of overeating, with subsequent chest pain that may be confused with cardiac chest pain. Clinicians are very familiar with the heartburn/heart attack confusion and the necessary diagnostic evaluation, and frequently educate patients about ways to distinguish between these 2 scenarios.

However, we don’t do as good of a job informing patients that overeating is a risk factor for a myocardial infarction (MI).[2] Can you speak about the assessment of patients on Thanksgiving who may be at higher risk for both reflux and an MI? Does anything change in your approach to these patients?

Dr. Glatter: The main issue we typically see at this time of year is holiday heart syndrome, which is caused by the combination of alcohol and overeating — often, binge drinking and binge eating — in people with otherwise normal hearts. This leads to supraventricular arrhythmias, typically atrial fibrillation. Sometimes caffeine adds to the mix, and you can have illicit substances too, but typically it is the alcohol and food that put a patient at risk.

People with cardiac disease, including known atrial fibrillation, can experience this syndrome, too. If these patients are consuming large amounts of alcohol as well as overeating, they may experience this arrhythmia. Generally, though, we often see it in people without any preexisting history of heart disease or arrhythmias.

This syndrome usually responds to hydration, typically via intravenous fluids. Medications for rate control are sometimes necessary; however, if the heart rate does not exceed 110-120 beats/min and the patient is really clinically stable, fluids are all they need and this rhythm disturbance clears spontaneously. If rate control medications are used, patients may never require further medications in the future.

It seems that alcohol has a direct cardiotoxic effect on the heart but may also lead to hyponatremia. Alcohol also triggers a surge of epinephrine and norepinephrine which tends to, we believe, promote the development of the arrhythmia in those at risk. An arrhythmia sometimes can lead to a supply-and-demand imbalance in terms of coronary blood flow, putting those at risk for MI at a higher level of risk.”

If you’d like to read even more about this condition, check this out:  http://emedicine.medscape.com/article/155050-overview.

Enjoy — in moderation!