Introduction
Holiday heart syndrome is also known as alcohol-induced atrial arrhythmia. Arrhythmia refers to an abnormal heartbeat. Holiday heart syndrome is atrial fibrillation due to a high intake of alcohol. This syndrome derived its name due to the fact that, during holidays, the general public tends to indulge and overdo alcohol consumption. Philip Ettinger, in 1978 coined the term HHS or Holiday Heart Syndrome after conducting research on people who had a history of heavy consumption of alcohol but no record of any other cardiovascular disease. It was found that all the subjects manifested clinical signs of cardiac arrhythmia due to alcohol over intake.
During holiday heart syndrome, the heart displays a disturbed heartbeat. Alcohol, which is chemically ethanol, gets built up in the body, forming metabolites that lead to structural changes at a cellular level in the cardiovascular system. One of the frequently found metabolites is acetaldehyde which is formed by the liver after a chemical reaction with alcohol dehydrogenase. This causes dysfunction of the mitochondria in cells, leading to cell death. It also gives rise to oxidative damage, altered synthesis of proteins, changed calcium transport, and eventually results in decreased function of the molecules protecting the cardiovascular system.
What Causes Holiday Heart Syndrome?
The prevalence of holiday heart syndrome is not certain due to inconsistent documentation. Many studies prove that alcohol is the leading cause of many arrhythmias, specifically atrial fibrillation. Atrial fibrillation can be understood as irregular and extremely rapid heart rhythms (arrhythmia) that can be a causative agent for cardiac blood clots. Binge drinking in the youth has led to an increase in the incidence rate of holiday heart syndrome amongst them.
There are only a few evident causes that lead to holiday heart syndrome, and they are the following:
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Immoderate alcohol intake.
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Raised levels of stress.
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Dehydration.
What Are the Signs and Symptoms of Holiday Heart Syndrome?
There is clear-cut evidence that changes at a cellular level, specifically the mitochondria, happen in holiday heart syndrome. Patients have reported an experience of a racing or a fluttering sensation in their chest. Heart palpitations and sudden pounding in the chest are also reported. There is increased lethargy due to a quick loss of energy. Patients feel seriously tired and light-headed or at times even faint. There is the presence of chest discomforts such as pressure or pain. Heartbeats are sometimes very slow or may be felt as being paused. On the other hand, the heartbeats increase to a speed wherein it feels like the heart is skipping a beat. It gets difficult to breathe, leading to shortness of breath during both normal activities or being at rest.
How to Diagnose Holiday Heart Syndrome?
Correct history of events and a rigorous physical examination are keys to diagnosing holiday heart syndrome. It is expected from the patient to honestly share their indulgence of alcohol and the approximate amount they had ingested. This will not only lead to a quick and authentic diagnosis but also an exact treatment plan for faster recovery. Another important aspect is to rule out the clinical symptoms for any other cardiovascular diseases because most of the symptoms of holiday heart disease are parallel to multiple cardiac conditions. Thus history taking is exceptionally crucial. A cardiac examination is simultaneously conducted to ensure the patient is not suffering from any underlying cardiac issues. It should be noted that seldom arrhythmias are not shown during tests and diagnostic procedures. That is why it is necessary to repeat some of the cardiac tests in a suspected case of holiday heart syndrome. To prove evidence of alcohol within the system, a complete blood picture, metabolic panel, alanine to aminotransferase ratio, liver functioning, magnesium levels, thiamine levels, and urine picture are some of the tests and markers. An electrocardiogram discloses any atrial fibrillation or other arrhythmias. Echocardiogram, x-rays, and liver ultrasound are other diagnostic tools to pin down an ongoing holiday heart syndrome in an individual.
What Is the Treatment and Management of Holiday Heart Syndrome?
The critical point during management is being aware that holiday heart syndrome is a reversible condition. Cardioversion is the first line of action for treating holiday heart syndrome. Cardioversion can be understood as reversing the abnormal heartbeat in a patient into a normal heartbeat by passing electric shocks via electric pads onto the heart. In case the patient does not show any clinical manifestation of arrhythmia or atrial fibrillation but is diagnosed with holiday heart syndrome after multiple procedures, therapy is indicated. The treatment does not get over only by emergency management. It should also be noted and understood how the overtake of alcohol takes place. if there is a mental reason behind the same, self-harm or a case of alcohol addiction, etc. It is expected from the patient to collaborate with AA (Alcohol Anonymous) or other chains that encourage cutting off alcohol and the habit of overdrinking.
Conclusion
Holiday heart syndrome is a condition that occurs after a massive intake of alcohol in a short frame of time. This reversible condition needs to be diagnosed at the earliest, and history documentation is the critical factor for this. Holiday heart syndrome leads to abnormal heartbeats ranging from rapid to slow heartbeats. A complete cardiac examination, liver function tests, urine and blood pictures, along with several other physical examination tools, are conducted to diagnose holiday heart syndrome. The treatment plan is according to the symptoms presented, but cardioversion remains the golden standard for treating holiday heart syndrome. Post management, the core reason for heavy alcohol intake, is researched. Based on the results, the patient is advised to consult a mental health professional or other consultants based on the risk factors present. Working together with a team of professionals can help withdraw dependence on alcohol with a pleasant outlook on life.
