Excerpt for Holiday Heart Syndrome, A Simple Guide To The Condition, Diagnosis, Treatment And Related Conditions by , available in its entirety at Smashwords

Holiday Heart Syndrome,





The Condition,




Related Conditions


Dr Kenneth Kee

M.B.,B.S. (Singapore)

Ph.D (Healthcare Administration)

Copyright Kenneth Kee 2018 Smashwords Edition

Published by Kenneth Kee at


This book is dedicated

To my wife Dorothy

And my children

Carolyn, Grace

And Kelvin

This book describes Holiday Heart Syndrome, Diagnosis and Treatment and Related Diseases which is seen in some of my patients in my Family Clinic.

(What The patient Need to Treat Holiday Heart Syndrome)

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Thank you for respecting the hard work of this author.


I have been writing medical articles for my blog (A Simple Guide to Medical Disorder) for the benefit of my patients since 2007.

My purpose in writing these simple guides was for the health education of my patients.

Health Education was also my dissertation for my Ph.D (Healthcare Administration).

I then wrote an autobiolographical account of his journey as a medical student to family doctor on his other blog

This autobiolographical account “A Family Doctor’s Tale” was combined with my early “A Simple Guide to Medical Disorders” into a new Wordpress Blog “A Family Doctor’s Tale” on

From which many free articles from the blog was taken and put together into 800 eBooks.

Some people have complained that the simple guides are too simple.

For their information they are made simple in order to educate the patients.

The later books go into more details of medical disorders.

The first chapter is always from my earlier blogs which unfortunately tends to have typos and spelling mistakes.

Since 2013, I have tried to improve my spelling and writing.

As I tried to bring the patient the latest information about a disorder or illness by reading the latest journals both online and offline, I find that I am learning more and improving on my own medical knowledge in diagnosis and treatment for my patients.

Just by writing all these simple guides I find that I have learned a lot from your reviews (good or bad), criticism and advice.

I am sorry for the repetitions in these simple guides as the second chapters onwards have new information as compared to my first chapter taken from my blog.

I also find repetition definitely help me and maybe some readers to remember the facts in the books more easily.

I apologize if these repetitions are irritating to some readers.

Chapter 1

Holiday Heart Syndrome

What is Holiday Heart Syndrome?

Holiday Heart Syndrome is a severe medical disorder normally occurring during the holiday season of Thanksgiving, Christmas, or New Year.

This disorder happens when people over-indulge in taking large quantities of food, alcohol, salt, and caffeine.

The main medical manifestation of Holiday Heart Syndrome is anomaly in the rate and rhythm of the heart.

The most often seen arrhythmia is atrial fibrillation (AF), in which the atria (top chambers of the heart) quiver or fibrillate inducing the heart to beat irregularly and often quite fast.

This can make patients feel acutely sick.

If left untreated, this disorder can lead to possible severe complications like stroke or a heart attack.

A more regular arrhythmia, called atrial flutter, or premature beats (extra beats) coming from either the top or bottom chambers may be observed as well.

Holiday Heart Syndrome can also produce considerable injury to the heart and lead to another serious disorder called cardiomyopathy in which there are enlarged heart muscles.

This disorder was most often observed in patients without underlying heart disease.

The heartbeat irregularity, called supra-ventricular arrhythmia (or above the ventricles), most often resolves once the alcohol is broken down and excreted by the person’s system.

This acute holiday heart syndrome can happen in the situation of a high degree of stress, illness or dehydration

There has been shown a link between excessive alcohol ingestion (binge drinking) and onset of a heart rhythm disturbance.

Holiday heart syndrome can be the result of stress, dehydration, and drinking alcohol.

It is occasionally linked with binge drinking that is frequent during the holiday season.

The disorder can also happen when persons consume only moderate quantities of alcohol.

Irregular heartbeats can be serious.

If palpitations persist for longer than a few hours patients should seek medical attention.

Some arrhythmias linked with holiday heart syndrome after binge drinking can lead to sudden death, which may explain some of the sudden death cases often reported in alcoholics.

Symptoms normally resolve themselves within 24 hours.

Holiday heart syndrome can also produce abnormal burning sensation during urination and the feeling of passing blood just like a kidney stone.

This generally subsides in days or weeks.

There is some proof that alcohol consumption is cardiotoxic.

In susceptible persons, the heart muscle can be seriously weakened when exposed to alcohol.

When the heart muscle becomes weaker, the heart pressures rise, and the upper chambers expand and develop AF.

Fortunately, this situation is rare.

When alcohol is toxic to the heart, it can be profound.

What are the causes of Holiday Heart Syndrome?


The majority of the cases of Holiday Heart Syndrome are caused due to eating lots of food, consuming excess alcohol and caffeine.

Studies have found that most of the cases of emergency room visits because of cardiac symptoms take place during the holiday season, mostly Christmas and New Year.

Stress is also a factor in causing Holiday Heart Syndrome.

It is not clearly known why people with an otherwise normal heart can develop these acute heart rhythm disturbances in the setting of alcohol, stress or dehydration.

There are other possible causes of AF after heavy alcohol consumption, such as:

1. Surges in the body’s adrenalin (sympathetic output),

2. Rises in the level of free fatty acids,

3. Alterations of the electrical currents of the heart through altering how sodium moves in and out of the heart cells, and

4. Lowering the levels of sodium, potassium, and magnesium in the body through diuresis.

Theories have been suggested, such as:

1. A link with release of epinephrine or nor-epinephrine (stress hormones that raise heart rate),

2. Sensitivity to alcohol (a toxin),

3. A rise in fatty acids in the blood,

4. Stress (maybe due to elevated cortisol levels) or

5. Dehydration.

Whatever the cause, holiday heart syndrome normally resolves once the precipitating event stops.


When a person eats a large quantity of meal, it leads to the stomach to expand so as to hold the large quantity of food.

This leads to a stretching reflex which activates the nervous system leading to higher heart rate and rhythm like atrial fibrillation.

Consuming a large quantity of food at one sitting induces the stomach and bowels to stretch and distend to hold it.

This stimulates the nervous system in the body known as the parasympathetic nervous system (vagal) which is used to help:

1. Digest food,

2. Rest, and

3. Sleep.

When stimulated, this nervous system normally slows the heart rate.

In people susceptible to AF, small areas in the upper chambers of the heart are activated and actually start to beat very fast, resulting in the abnormal heart rhythm.

These areas often dwell in the small veins that pass blood from the lungs into the left upper heart chamber.

Excess Salt Consumption:

When salt is taken in excess quantity it leads to the blood pressure to rise.

If a person has a history of hypertension, heart valve disorders or heart failure this increase in the blood pressure and higher quantity of fluid in the body can activate atrial fibrillation.

Persons with a previous history of congestive heart failure are at a special danger for having a heart failure if they eat too much salt.

The body needs salt but when a person eats too much of it, the body can hold the fluid, which produces blood pressure to rise.

In people with a history of high blood pressure, heart valve problems, or heart failure, the rise in blood pressure and the higher quantity of fluid in the body can expand the upper heart chambers and induce AF to develop.

Excessive Drinking:

Red wine if consumed in temperance is good for the heart but excess consumption may activate an atrial fibrillation as excess consumption of alcohol causes the alcohol to be cardiotoxic and causes the heart to be weak.

When there is weakness of the heart muscles, it makes it much harder for the heart to pump blood to the rest of the body and as a result atrial fibrillation happens.

Also, heavy intake of alcohol can produce higher amount of adrenaline and other stress hormones which may also activate heart rhythm abnormalities or atrial fibrillation.

This is particularly true for a person with already a cardiac history.

It is advised that the holidays are there to enjoy and be merry but this should be done in temperance and with the least stress so as to avoid Holiday Heart Syndrome.

Right about now a person may be asking, "I heard that alcohol is healthy for the heart?"

It is but in only low to moderate quantities.

At one or two drinks a day for women and one to three drinks for men, alcohol is known to have a protective effect on the heart and is linked with lower levels of coronary artery disease, cerebral vascular disease, and peripheral vascular disease.

There are other danger factors for AF that is higher around the holidays as well.

Finally, heart injury or heart attacks tend much more likely during the holidays.

Actually, deadly heart attacks most often happen on December 25 compared with all other days of the year.

The second most frequent day is December 26 and the third, January 1.

Probable reasons for why these heart attacks happen during the holidays are:

1. Delaying regular check-ups or doctor’s appointments

2. Cold weather

3. Overeating

4. Depression

Regarding AF, any heart injury, such as a heart attack, can produce irritation to the upper heart chambers and induce the abnormal heart rhythm to develop.

What are the symptoms of Holiday Heart Syndrome?


The symptoms of holiday heart are linked to an irregular and often fast heart rate.

These are:

1. Palpitations (a feeling of pounding in the chest, racing or skipping heart beats),

2. Shortness of breath particularly with exertion,

3. Fatigue,

4. Chest discomfort or pain or

5. Dizziness and feeling faint.

Some of the symptoms of Holiday Heart Syndrome are:

1. Rapid pulse

2. Dyspnea

3. Chest pain

4. Ankle edema.

In some patients the heart rate rises so much that the person may even have a syncopal event.

While holiday heart normally passes off rapidly and is not life-threatening, it is significant that the person does not ignore these symptoms.

If a person has underlying heart disease, chest pain and shortness of breath, it can also indicate a heart attack.

Rapid medical treatment is required to find and correct the cause of the symptoms.

It is believed that AF is activated in holiday heart syndrome due to the effects of overindulgence.

Alcohol intake can:

1. Disrupt the electrical system of the heart,

2. Alter electrolyte levels in the blood and

3. Raise the release of stress hormones such as adrenaline and cortisol.

In turn, these alterations in body chemistry can lead to the initiation of AF.

These effects can be aggravated by:

1. Stress,

2. Sleep deprivation and

3. Overeating.

AF can be serious.

It can result in stroke in patients who are at higher danger.

How is Holiday Heart Syndrome Diagnosed?


Normally, if a person has symptoms indicative of Holiday Heart Syndrome then he or she should be brought to the emergency room immediately.

The doctor should assess serum electrolyte levels, mainly potassium, in all patients with acute arrhythmias.

A 12-lead electrocardiography is necessary to rule out other cardiac pathology such as:

1. Ischemia,

2. Infarction,

3. Pulmonary embolism, or

4. Hypertrophy.

Echocardiography has become the standard diagnostic method to evaluate:

1. Chamber enlargement,

2. Left ventricular (LV) wall motion abnormalities,

3. Hypertrophy,

4. Valvular disease, and

6. Systolic dysfunction.

In patients at danger for coronary artery disease, more cardiac imaging (e.g., perfusion imaging, echocardiography) may be required.

After the resolution of holiday heart syndrome and return of sinus rhythm, treadmill stress testing is sensible in some patients to search for exercise-linked arrhythmia after the acute effects of alcohol have resolved

What is the treatment of Holiday Heart Syndrome?


Once the patient reaches the emergency room then routine ECG monitoring will be done to examine the status of the heart rate.

In some patients treatment with beta blockers may be given for regulating the heart rate in case if the atrial fibrillation persists for more than 24 hours.

In circumstances where beta blockers or other medicines to regulate the heart rate can not be given then cardioversion may be indicated.

In most cases of Holiday heart Syndrome, the patient is admitted into hospital for at least 24 hours for observation and to reduce the heart rate.

Patients who are young and do not have any underlying heart anomalies and are perfectly healthy otherwise can be discharged once their heart rate goes down

Generally, there are fewer complications from atrial fibrillation among alcoholic patients than among non-alcoholics

Most (90%) holiday heart syndrome patients convert spontaneously to a normal sinus rhythm with proper medical treatment.

The doctors may require treating the patient with medicines to slow the heart rate down.

The treatment is intravenous diltiazem which regulated the ventricular rate.

The arrhythmia fails in some patients to spontaneously convert after 4 days of alcohol detoxification therapy.

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