Holiday heart syndrome, also known as alcohol-induced atrial arrhythmias, is a
syndrome
A syndrome is a set of medical signs and symptoms which are correlated with each other and often associated with a particular disease or disorder. The word derives from the Greek language, Greek σύνδρομον, meaning "concurrence". When a sy ...
defined by an
irregular heartbeat associated with high levels of
ethanol
Ethanol (abbr. EtOH; also called ethyl alcohol, grain alcohol, drinking alcohol, or simply alcohol) is an organic compound. It is an alcohol with the chemical formula . Its formula can be also written as or (an ethyl group linked to a ...
consumption. Holiday heart syndrome was discovered in 1978 when
Philip Ettinger discovered the connection between arrythmia and alcohol consumption. It received its common name as it is associated with the
binge drinking common during the holidays.
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 63%.
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
The blood circulatory system is a system of organs that includes the heart, blood vessels, and blood which is circulated throughout the entire body of a human or other vertebrate. It includes the cardiovascular system, or vascular system, tha ...
. It may also shorten the
refractory period of the
atrium
Atrium may refer to:
Anatomy
* Atrium (heart), an anatomical structure of the heart
* Atrium, the genital structure next to the genital aperture in the reproductive system of gastropods
* Atrium of the ventricular system of the brain
* Pulmona ...
. Another possibility is that alcohol consumption increases the level of
catecholamines, which increased the level of
P-waves
A P wave (primary wave or pressure wave) is one of the two main types of elastic body waves, called seismic waves in seismology. P waves travel faster than other seismic waves and hence are the first signal from an earthquake to arrive at any ...
, and therefore the risk of arrythmia. Alcohol intake can also lead to a rise in
plasma free
fatty acids
In chemistry, particularly in biochemistry, a fatty acid is a carboxylic acid with an aliphatic chain, which is either saturated and unsaturated compounds#Organic chemistry, saturated or unsaturated. Most naturally occurring fatty acids have an B ...
and an increase in the activity of the
sympathetic nervous system. An
ATP2A2
ATP2A2 also known as sarcoplasmic/endoplasmic reticulum calcium ATPase 2 (SERCA2) is an ATPase associated with Darier's disease and Acrokeratosis verruciformis.
This gene encodes one of the SERCA SERCA, or sarco/endoplasmic reticulum Ca2+-ATP ...
enhancer known as
JNK2
c-Jun N-terminal kinases (JNKs), were originally identified as kinases that bind and phosphorylate c-Jun on Ser-63 and Ser-73 within its transcriptional activation domain. They belong to the mitogen-activated protein kinase family, and are re ...
may play a role. Alcohol may activate it, which can effect other
proteins therefore increasing the risk of
arrythmia. Heavy consumption of alcohol may lead to an increased level of ethanol and
metabolites
In biochemistry, a metabolite is an intermediate or end product of metabolism.
The term is usually used for small molecules. Metabolites have various functions, including fuel, structure, signaling, stimulatory and inhibitory effects on enzymes, ...
such as
acetaldehyde inside of the body. All of these factors can contribute to arrythymia.
Drinking large quantities of alcohol or
caffeine
Caffeine is a central nervous system (CNS) stimulant of the methylxanthine class. It is mainly used recreationally as a cognitive enhancer, increasing alertness and attentional performance. Caffeine acts by blocking binding of adenosine to ...
, eating
fatty foods with
salt
Salt is a mineral composed primarily of sodium chloride (NaCl), a chemical compound belonging to the larger class of salts; salt in the form of a natural crystalline mineral is known as rock salt or halite. Salt is present in vast quant ...
, heightened levels of
stress
Stress may refer to:
Science and medicine
* Stress (biology), an organism's response to a stressor such as an environmental condition
* Stress (linguistics), relative emphasis or prominence given to a syllable in a word, or to a word in a phrase ...
, and
dehydration
In physiology, dehydration is a lack of total body water, with an accompanying disruption of metabolic processes. It occurs when free water loss exceeds free water intake, usually due to exercise, disease, or high environmental temperature. Mil ...
are all
risk factors
In epidemiology, a risk factor or determinant is a variable associated with an increased risk of disease or infection.
Due to a lack of harmonization across disciplines, determinant, in its more widely accepted scientific meaning, is often use ...
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.
Usually patients with this disorder lack any
family history
Genealogy () is the study of families, family history, and the tracing of their lineages. Genealogists use oral interviews, historical records, genetic analysis, and other records to obtain information about a family and to demonstrate kin ...
or previous clinical evidence of cardiological problems.
Symptoms and Complications
The most common symptoms people with HHS have are
heart palpitations and
arrhythmia. People usually present with
atrial fibrillation; however, other forms of arrythmia may be developed, such as
atrial tachycardia
Atrial tachycardia is a type of heart rhythm problem in which the heart's electrical impulse comes from an ectopic pacemaker (that is, an abnormally located cardiac pacemaker) in the upper chambers ( atria) of the heart, rather than from the sino ...
,
premature ventricular contraction, and
atrial flutter
Atrial flutter (AFL) is a common abnormal heart rhythm that starts in the atrial chambers of the heart. When it first occurs, it is usually associated with a fast heart rate and is classified as a type of supraventricular tachycardia. Atrial f ...
. Patients with HHS also frequently report
precordial pain,
sweating,
anxiety
Anxiety is an emotion which is characterized by an unpleasant state of inner turmoil and includes feelings of dread over anticipated events. Anxiety is different than fear in that the former is defined as the anticipation of a future threat wh ...
,
shortness of breath
Shortness of breath (SOB), also medically known as dyspnea (in AmE) or dyspnoea (in BrE), is an uncomfortable feeling of not being able to breathe well enough. The American Thoracic Society defines it as "a subjective experience of breathing di ...
, and
syncope.
Strokes
A stroke is a medical condition in which poor blood flow to the brain causes cell death. There are two main types of stroke: ischemic, due to lack of blood flow, and hemorrhagic, due to bleeding. Both cause parts of the brain to stop funct ...
and
cardiac arrest
Cardiac arrest is when the heart suddenly and unexpectedly stops beating. It is a medical emergency that, without immediate medical intervention, will result in sudden cardiac death within minutes. Cardiopulmonary resuscitation (CPR) and poss ...
can also occur in people with this syndrome.
People with Holiday heart syndrome have a heightened risk of
dilated cardiomyopathy
Dilated cardiomyopathy (DCM) is a condition in which the heart becomes enlarged and cannot pump blood effectively. Symptoms vary from none to feeling tired, leg swelling, and shortness of breath. It may also result in chest pain or fainting. Co ...
,
rhabdomyolysis,
acute kidney injury
Acute kidney injury (AKI), previously called acute renal failure (ARF), is a sudden decrease in kidney function that develops within 7 days, as shown by an increase in serum creatinine or a decrease in urine output, or both.
Causes of AKI are c ...
, and
electrical injuries.
The heightened level of acetaldehyde this syndrome causes can result in
mitochondrial dysfunction,
valvular disease,
oxidative damage
Oxidative stress reflects an imbalance between the systemic manifestation of reactive oxygen species and a biological system's ability to readily detoxify the reactive intermediates or to repair the resulting damage. Disturbances in the normal r ...
,
cell death
Cell death is the event of a biological cell ceasing to carry out its functions. This may be the result of the natural process of old cells dying and being replaced by new ones, as in programmed cell death, or may result from factors such as d ...
, lowered effects of
cardioprotective molecules, and an altered
calcium transport and
protein synthesis system.
If left untreated, it can result in
thrombosis
Thrombosis (from Ancient Greek "clotting") is the formation of a blood clot inside a blood vessel, obstructing the flow of blood through the circulatory system. When a blood vessel (a vein or an artery) is injured, the body uses platelets (t ...
,
pneumonia
Pneumonia is an inflammatory condition of the lung primarily affecting the small air sacs known as alveoli. Symptoms typically include some combination of productive or dry cough, chest pain, fever, and difficulty breathing. The severi ...
,
cirrhosis
Cirrhosis, also known as liver cirrhosis or hepatic cirrhosis, and end-stage liver disease, is the impaired liver function caused by the formation of scar tissue known as fibrosis due to damage caused by liver disease. Damage causes tissue rep ...
, and
heart failure.
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
Cardioversion is a medical procedure by which an abnormally fast heart rate ( tachycardia) or other cardiac arrhythmia is converted to a normal rhythm using electricity or drugs. Synchronized electrical cardioversion uses a therapeutic dose ...
or other treatments for arrhythmia are used.
References
Further reading
*
*
External links
{{Heart diseases
Cardiac arrhythmia
Syndromes
Christmas