Story shorts: Drinking, Holiday Heart Syndrome, and Smoking

What is The Holiday Heart Syndrome?

By Patrick Neustatter, MD

My brother-in-law, Olly, likes a spot of red wine, but usually by the bottle rather than by the glass. When my wife Paula and I were visiting, he managed to drink himself into the "holiday heart syndrome", despite it not being the holidays. Now that the holidays, in all their horror, are actually upon us, let me tell you this salutatory tale.

Alcohol, which is of course the hallmark of the holiday season for anyone who is a serious party animal, has the ability to tickle up those specialized nerve cells in the heart. Then, what is meant to be an orderly progression of the electrical impulse to the heart muscle to make the heart beat—or pump to be more precise—becomes a bit chaotic.

Atrial fibrillation is the commonest specific arrhythmia caused by alcohol, and this whole phenomenon got named "the Holiday Heart Syndrome" (HHS for short) following an analysis of 32 patients who had "dysrhythmic episodes" after having been on a bender.

Symptoms are liable to be palpitations, which is a prominent or irregular heart beat. Or if the arrhythmias persistent, it may impair the hearts pumping ability, causing weakness, shortness of breath, even angina: the cramp like pain across the chest that typifies coronary artery disease, when there's not enough blood flow to the coronary arteries to oxygenate the heart muscle. Incidentally, some claim HHS can also be induced by marijuana – so potheads beware also.

It is common for my sister Angie, and Olly, to have fairly well-oiled dinner parties when we are over, when we are catching up with all our friends. The morning after one of these, Olly complained he hadn't slept well and he felt kind of peaky. When I felt I his pulse, it was definitely irregular, and my diagnosis was he had gone into atrial fibrillation—as he has in the past. His regular doctor being closed, we took a taxi to University College Hospital in London.

Despite the fact that on the way he suddenly announced "I feel a lot better", and when I felt his pulse it seemed to be back in regular normal sinus rhythm, we continued on. Olly was whisked into the British hospital, examined, had an ECG and was deemed cured, all in a matter of about 45 minutes.
So this story had a happy ending. But arrhythmias and atrial fibrillation can cause sudden death, according to a review in the Brazilian journal Arquivos Brasileiros de Cardiologia. And atrial fibrillation especially can lead to the formation of blood clots that can cause strokes.

Alcohol can do other bad things to your heart but even if you're not a regular drinker, if you're tempted to gargle to excess at the office Christmas party or New Years eve, be warned, you might just short circuit your heart's vulnerable wiring.

Patrick Neustatter, M.D. ​practiced primary care for more than 40 years. Develop​ing​ an interest in coaching patients to help themselves and throw off the ingrained notion that "the doctor knows best, " he recently published Managing Your Doctor: The Smart Patient's Guide to Getting Effective, Affordable Healthcare​

Who is most likely to smoke?

The overall number of people who smoke is at an all-time low, but not everyone is ready to celebrate. Smoking rates remain alarmingly high among three groups: those with mental health issues, the LGBT community and American Indians.

Those with mental illness smoke at a rate of 36 percent - more than twice the national average. Research suggests those in the LGBT community are up to 200 percent more likely than others to be addicted to cigarettes. More than 26 percent of American Indians are smokers, the highest rate of any ethnic group and considerably higher than the national average.

Quitline experts are working to better help counsel members of these groups by offering coaches in their demographic. "We're making great strides, but it's evident that there are large groups of people who continue to struggle with tobacco and the chronic diseases associated with it," said Amy Lukowski, Psy.D., clinical director of Health Initiatives at National Jewish Health in Denver.

The quitline at National Jewish Health is the largest non-profit smoking quitline in the country, fielding up to 22,000 calls per day. Those wanting to quit can call 1-800-QUIT-NOW, to be directed to their individual state quitline.

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