Holiday Heart Syndrome: Knowing the signs could save a life

Your health doesn’t take a holiday.

Especially your heart.

“Heart health in December is just as important, if not more important, as it is in January,” said Dr. Quinn Pack, a preventive cardiologist in the Heart & Vascular Program at Baystate Medical Center.

Holiday heart syndrome is also recognized by physicians as a very real and potentially deadly phenomenon. If left untreated, it can result in serious complications including heart attack and stroke, as well as enlargement of the heart muscles called cardiomyopathy.

Baystate Health experts share the risk factors for holiday heart syndrome and how to get rid of it.

What is holiday heart syndrome?

Holiday heart syndrome (HHS) was first identified in 1978 by Dr. Philip Ettinger.

It is when healthy people without heart disease known to cause arrhythmia (irregular heart rhythm) experience an acute cardiac rhythm disturbance known as atrial fibrillation after excessive alcohol intake. Dr. Ettinger came up with the name since episodes of these cardiac arrhythmias – which can happen in regular and non-regular drinkers – typically occurred after weekends or holidays.

What is the cause of holiday heart syndrome?

Now we know holiday heart syndrome is also the result of a combination of factors beyond just drinking alcohol, including:

• Caffeine
• Over-consumption of fatty meals filled with salt
• Stress

We see these factors combine for celebrations that can accompany Thanksgiving, Hanukkah, Christmas, and New Year’s Eve.

Alcohol Consumption

In a study published in 2013 by the U.S. National Library of Medicine entitled “Holiday Heart Syndrome Revisited after 34 Years,” its authors noted “alcohol has a definite role in cardiac arrhythmia, either by chronic abuse or by binge drinking.” They further noted that for patients visiting the emergency room with palpitations or other symptoms associated with cardiac arrhythmia, a “high suspicion of HHS should occur” if the patient exhibits signs of being intoxicated or admits to a recent episode of binge drinking.

The authors concluded that after the diagnosis of cardiac arrhythmia without evident heart disease, the physician should “explain the syndrome to the patient and recommend alcohol abstinence in an effort to prevent new episodes of HHS.”

While people with a history of heart failure or other cardiac conditions are at greater risk for serious complications, those who are otherwise healthy usually see their arrhythmia stabilized after treatment in an emergency room with beta blockers and other medications to reduce their heart rate.

Caffeine

The temptation of holiday-themed coffee drinks or a late-night coffee chat with family may mean people are consuming more caffeine than they're used to. Too much caffeine can make your heart race.

Caffeine can also cause dehydration, which can lead to arrhythmia.

A 2023 study in the journal Heart Rhythm O2 found that caffeine and alcohol are often consumed together, and their combination can cause irregular heart rhythms. It's common at the holidays to consume more of these substances, and to consume them together. Be aware that it could increase your risk for irregular heart rhythm.

Overeating and weight gain

Whether enjoying a fabulous feast with friends and family at home or at a restaurant and at parties, it’s important to make sure you don’t overeat.

Cardiologist Dr. Amir Lotfi of the Heart & Vascular Program at Baystate Medical Center, reminds holiday diners that moderation is the key. This is especially important for those suffering from high blood pressure, high cholesterol, diabetes and heart disease.

“An unusually heavy meal such as one the holidays are known for, or at any time of the year, can put additional stress on the heart as your meal is digested, and overeating and over-drinking can increase your blood pressure and heart rate,” said Dr. Lotfi.

These meals tend to be associated with very high salt intake, which can lead to high blood pressure.

Also, some research suggests that enjoying just one huge meal, despite previous healthy eating habits, is a bad thing and can quadruple the ordinary risk of a heart attack during the two hours after eating.

The good news is that the risk is all but gone as the clock strikes the third hour.

Dr. Pack says it’s also important to look at the weight gain associated with overeating during the holidays.

“Some research suggests that much of the permanent weight gain in the average U.S. citizen is put on during the holidays. A typical person might gain 3 to 5 pounds during the holidays, but only lose 2 or 3 pounds in January. So, we end up keeping one to two pounds permanently, which can really add up over all the years,” said Dr. Pack.

Try to focus on maintaining weight during the holidays, rather than losing weight.

“Certainly, you want to enjoy yourself and the wonderful foods that are available to us at this time of year, but significant caution is also advised. Get on the bathroom scale, reduce your portion size, and cut back on any excesses so that you can avoid gaining even a little weight,” Dr. Pack said.

Stress

Don’t forget the stress that the holidays places on many of us.

“My sage advice, and there is no medicine in it, is that it is better to simplify and emphasize family and friends rather than trying to create the perfect Norman Rockwell holiday,” said Dr. Pack.

Stress leads to anxiety and the release of epinephrine into the blood system sometimes contributing to a rapid or irregular heartbeat.

Studies have shown that not only are the winter holidays associated with heart problems, but that when they do happen, they are more likely to be fatal. According to a 2004 study published in the journal Circulation, researchers discovered increases of 5% more heart-related deaths during the holiday season.

Other risk factors for heart health problems

Cold weather puts strain on your heart

For many, the winter holidays mean cold weather, which is hard on the heart and puts extra strain on it.

“What happens is that your arteries tend to tighten up when you are out in the cold, your blood pressure goes up, and this can overload your heart, possibly leading to a heart attack. If you have previously suffered a heart attack or have heart disease, you should avoid shoveling snow and other types of outdoor exertion, particularly if you are out of shape and haven’t been exercising regularly. Let someone else do it, like a nephew or neighbor. And be sure to bundle up when going out into the cold,” said Dr. Pack.

He added that while the combination of cold weather and shoveling can increase one’s chances of having a heart attack, the likelihood is about 1 in 100,000 people, still a small chance.

“We do see three to five extra heart attack victims in our cardiac intensive care unit after each snow storm,” said Dr. Pack.

As for the cold weather itself, Dr. Pack said it’s not so much the day-to-day cold of the winter that poses a threat, as much as it is a sudden shift in weather.

“Literature suggests that these sudden shifts, such as going from warm to cold in a very short time, puts extra stress on the heart leading to a possible heart attack,” he said. “But I like to put things into perspective. These are small risks compared to the risks that smoking, diabetes, hypertension, being overweight and physical inactivity in the colder months, all place on your chances of developing coronary artery disease.”

Even in warmer areas of the country where the snow doesn’t fly, heart attack numbers rise just as they would in New England.

Lifestyle choices and managing your healthcare

While there are some risk factors that you can’t change, such as your family history, your sex and age, there are still many important risk factors that you can control, including:

• Smoking
• High blood pressure
• High blood cholesterol
• Being overweight
• Physical inactivity
• Diabetes

Visit your primary care doctor, who can assess your individual risk factors, then tailor a strategy for you to follow.

For smokers, Dr. Pack said he is “a big fan of addressing this bad habit first.”

“Smoking cessation may be hard but is a more satisfying risk factor to treat because once you stop, unless you relapse, then that’s it - you’re done. That’s different than diet and physical activity which require effort every day of your life,” he said.

Also, within one month of quitting smoking, your risk for heart disease drops substantially, he noted.

Holiday Heart Syndrome Symptoms

Dr. Lotfi blames it on the holidays.

“All too often people wait to decide to go to the emergency room because they don’t want to ruin the holiday for others, putting them at risk for greater consequences,” said Dr. Lotfi.

When it comes to saving your life or the life of someone else, everyone should know the warning signs of heart trouble. The most common symptoms of arrhythmia are:

• Palpitations (feelings that your heart is skipping a beat, fluttering, or beating hard or fast)
• A slow heartbeat
• An irregular heartbeat
• Feeling pauses between heartbeats.

More serious signs include:

• Anxiety
• Weakness
• Fainting or nearly fainting
• Sweating
• Shortness of breath
• Chest pain

The most common warnings that you might be experiencing a heart attack are:

• Chest pain or discomfort. Most heart attacks involve discomfort in the center or left side of the chest. The discomfort usually lasts for more than a few minutes or goes away and comes back. It can feel like pressure, squeezing, fullness, or pain. It also can feel like heartburn or indigestion. The feeling can be mild or severe.
• Upper body discomfort. You may feel pain or discomfort in one or both arms, the back, shoulders, neck, jaw, or upper part of the stomach (above the belly button).
• Shortness of breath. This may be your only symptom, or it may occur before or along with chest pain or discomfort. It can occur when you are resting or doing a little bit of physical activity.

Other common signs and symptoms include:

• Breaking out in a cold sweat
• Feeling unusually tired for no reason, sometimes for days (especially if you are a woman)
• Nausea (feeling sick to the stomach) and vomiting
• Light-headedness or sudden dizziness
• Any sudden, new symptoms or a change in the pattern of symptoms you already have (for example, if your symptoms become stronger or last longer than usual).

Note that women may experience different heart attack symptoms, so be aware that the traditional chest pain may not be the only sign.

What to do if you think you’re having heart issues

Holiday heart symptoms usually last 24 hours, but don’t assume it will get better on its own.

“It’s important for all of us to recognize the signs of a heart attack and to not wait to seek help. It is better to call 911 than to sit at home and stew about it. Unfortunately, heart attacks kill more people at home than in the hospital. If you can get to the nearest emergency room, your chances of dying from a heart attack go down dramatically. As a result, even if you aren’t absolutely sure that you are having a heart attack, the best course of action is to seek help immediately,” said Dr. Pack.

“Acting fast can save your life,” he added.

Holiday Heart Syndrome Treatment

Holiday heart is reversible and not permanent.

If you have symptoms, stop or at least significantly reduce your alcohol intake.

It might be helpful to join an Alcoholics Anonymous (AA) or other support groups. You may also consider calling the Substance Abuse and Mental Health Services Administration's Helpline for support and resources for substance use including excessive drinking.

"Celebrate with family and friends, eat modestly, avoid binge drinking, and, as always, remember that ‘exercise is medicine.’ Just be sure to do most of your exercise indoors this winter,” said Dr. Pack.