Beware of the 'holiday heart' hazard


It's two days after Christmas, and we hope everything went well with your holiday celebrations. With the season's overflowing food and drinks come the risk of potentially life-threatening complications, like the so-called "holiday heart" syndrome.

A week before Christmas, our cardiology fellow on duty at the Manila Doctor's Hospital called me up past midnight because an old patient of mine had been rushed to the emergency room (ER) with an irregular rhythm and a rapidly beating heart, at a rate of around 130 to 140 beats per minute. He came straight from a party where he had one drink too many, and suddenly felt chest tightness and severe palpitations.

Fortunately for him, his heart rhythm normalised and slowed down with intravenous medications promptly given by doctors on duty. Our cardiology fellow, who serves as our assistant in our absence, did not have to apply an electric shock on him.

Such cases increase in number during the holiday season; hence, the moniker "holiday heart syndrome." It actually includes other sudden cardiovascular events like an alarming rise in blood pressure, heart attack, stroke, and even sudden cardiac arrest.

A few years ago, the dailies carried the front-page story of three middle-aged brothers living in a remote Sicilian town, who all had a heart attack on the same day during the holiday season. Two of them died suddenly.

The third was fortunate to be in a hospital when he suffered a heart attack, and prompt intervention in the ER saved him.

Obviously, there must be something in the genes predisposing them to a heart attack, but the various physical and bacchanalian stresses of the holiday season can be the final straw.

However, it still goes to show that the "hypercelebration" of the season and the overcharged atmosphere can trigger serious complications in the heart, brain and circulation of unsuspecting individuals.

It is a challenge for physicians to identify patients at risk for holiday heart syndrome, and forewarn them. It could be life-saving for some to be aware of the incipient danger that comes with the usually hectic celebration.

Mentally, they could prepare themselves and have the discipline to say "no" when they have had enough partying, and the temperance not to overindulge in the rich food and drinks that come with the holiday celebrations.

Arrhythmia in the holiday heart syndrome has been associated with having six or more drinks, but fewer drinks could also be the culprit.

Excessive alcohol consumption has long been known to weaken heart muscles and cause a problem called alcoholic cardiomyopathy. With weakened cardiac musculature and a decline in function, the heart muscles become a substrate for life-threatening irregular heartbeats called arrhythmia.

But even for those who are not habitual drinkers, occasional alcohol bingeing has also been linked to arrhythmia called acute atrial fibrillation, like what our patient had.

When the name of the syndrome was coined by Ettinger et al in 1978, it was based on a study evaluating 32 separate arrhythmia episodes in 24 patients, who consumed alcohol heavily during a weekend or holiday drinking binge immediately before evaluation.

The authors described the results as an "acute cardiac rhythm and/or conduction disturbance (irregular heartbeat), most commonly supraventricular tachyarrhythmia (fast heartbeat), associated with heavy ethanol (alcohol) consumption in a person without other clinical evidence of heart disease."

The authors further reported that there was no recurrence of the arrhythmia with "subsequent abstinence from alcohol use."

Not the sole culprit

What you should know about alcohol and hangovers

  • The darker the shade of your choice of poison, the more likely it is going to cause a hangover the morning after.
  • This is because alcohol which are darker in colour denotes a higher level of congeners - products of alcohol fermentation.
  • Studies have shown that bourbon, for instance, has 37 times more congeners than vodka, a clear liquor.
  • Doctors suggest opting for light-coloured drinks - white wine over red wine,
  • or gin over whiskey.
  • This is because the liver is only able to break down half an ounce of alcohol (about one drink) per hour.
  • Any excess alcohol is circulated within the body until the liver has the ability to process it.
  • According to the Health Promotion Board, a standard alcoholic drink is a 330ml can of regular beer, a 175ml glass of wine or a 35ml nip of spirit.
  • This is when you start feeling the symptoms - the usual combination of a splitting headache, nausea, food aversion and that general feeling of wretchedness.
  • A hangover peaks only after the alcohol is totally eliminated from the blood.
  • Alcohol interferes with the secretion of the hormone that inhibits urination, which explains long queues at the loos in clubs.
  • Loading up on water in between drinks helps to dilute the alcohol in your blood.
  • Munching on bar snacks like peanuts or cheese in between drinks also help to line the stomach and reduce the absorption of alcohol.

Actually, alcohol is not the sole culprit. There are similar reports of the arrhythmia seen in the holiday heart syndrome with recreational use of marijuana. Those who take both alcohol and marijuana increase their risk greatly.

These, plus the nicotine effect in smokers (active and passive), bingeing on high-fat food, and a stressful, traffic-aggravated schedule can be a perfect mix for the syndrome, which can unfortunately convert the season of merrymaking into a period of grief for the victim's family. So, beware of all these "triggers."

Aside from avoiding binge drinking and eating, Robert A. Kloner, MD, PhD, a professor at the Keck School of Medicine at the University of Southern California, gives some pointers on how to prevent holiday heart syndrome:

- Dress warmly when it's cold.

- Avoid heart stressors, including too much physical exertion, anger and emotional stress.

- Get a flu shot yearly before the season (preferably at the start of the year). Infection and fever put extra stress on the heart.

- Avoid inhaling smoke in crowded places. Courteously remind those who still smoke in public places or during parties that they should refrain from doing so, as they also affect other people's health. Better yet, declare your parties strictly non-smoking parties.

- Avoid places where they make fires for warmth or to celebrate. In the States, heart patients are advised to stay away from the fireplace. One should avoid getting near bonfires. Ultra-fine particles in the air from burnt materials can be bad for the heart.

We wish you a joyful and healthful Yuletide season, and a bright new hope for the coming new year.