Holiday heart syndrome
Electrocardiographic image depicting Atrial_fibrillation
Electrocardiographic image depicting Atrial_fibrillation
ComplicationsMitochondrial dysfunction, valvular heart disease, oxidative damage, cell death, dilated cardiomyopathy, electrical vulnerability of the atrium, thrombosis, pneumonia, Cirrhosis, heart failure, and potentially death
Usual onsetUsually following heavy amounts of Alcohol consumption
DurationUsually 24 hours
CausesHigh amounts of ethanol consumption
Risk factorsDrinking large quantities of alcohol, dehydration, high levels of stress
Diagnostic methodBlood tests and Medical imaging
Differential diagnosisAlcohol use disorder, Dilated cardiomyopathy, Cirrhosis, Arrhythmia, Psychiatric disorders
PrognosisIf left untreated can have severe complications, and is possibly fatal

Holiday heart syndrome, also known as alcohol-induced atrial arrhythmias, is a syndrome defined by an irregular heartbeat and palpitations[1] associated with high levels of ethanol consumption.[2][3] Holiday heart syndrome was discovered in 1978 when Philip Ettinger discovered the connection between arrythmia and alcohol consumption.[4] It received its common name as it is associated with the binge drinking common during the holidays.[5] It is unclear how common this syndrome is. 5-10% of cases of atrial fibrillation may be related to this condition, but it could be as high 63%.[6]


Cardiologists are unsure exactly what causes Holiday heart syndrome. The ingestion of alcohol may slow down the Cardiac conduction system, which is an important system for managing the Circulatory system. It may also shorten the refractory period of the atrium. Another possibility is that alcohol consumption increases the level of catecholamines, which increased the level of P-waves, and therefore the risk of arrythmia. Alcohol intake can also lead to a rise in plasma free fatty acids and an increase in the activity of the sympathetic nervous system.[7][8] An ATP2A2 enhancer known as JNK2 may play a role. Alcohol may activate it, which can affect other proteins therefore increasing the risk of arrythmia.[9] Heavy consumption of alcohol may lead to an increased level of ethanol and metabolites such as acetaldehyde inside of the body.[10][11] All of these factors can contribute to arrythymia.[12]

Drinking large quantities of alcohol or caffeine,[13][14][15] eating fatty foods with salt,[16] heightened levels of stress,[17][18] and dehydration are all risk factors for the development of this syndrome. HHS can appear in people who do not usually drink. Often these people who rarely drink may engage in an episode of heavy alcohol consumption and develop it as soon as they drink, others contract it 12–36 hours following the time of intoxication.[19] Usually patients with this disorder lack any family history or previous clinical evidence of cardiological problems.[5]

Symptoms and complications

The most common symptoms people with HHS have are heart palpitations and arrhythmia.[20] People usually present with atrial fibrillation; however, other forms of arrythmia may be developed, such as atrial tachycardia, premature ventricular contraction, and atrial flutter. Patients with HHS also frequently report precordial pain, sweating, anxiety, shortness of breath, and syncope. Strokes and cardiac arrest can also occur in people with this syndrome.[5] People with Holiday heart syndrome have a heightened risk of dilated cardiomyopathy, rhabdomyolysis, and acute kidney injury[21] and increased atrial vulnerability to external electrical stimulus under the influence.[22]

The heightened level of acetaldehyde this syndrome causes can result in mitochondrial dysfunction, valvular disease, oxidative damage, cell death, lowered effects of cardioprotective molecules, and an altered calcium transport and protein synthesis system.[5] If left untreated, it can result in thrombosis, pneumonia, cirrhosis, and heart failure.[6][19] For most patients with HHS the syndrome only lasts 24 hours. However for 26% of people with this syndrome, they reexperience an episode of it within the next year. To treat patients with this condition cardioversion or other treatments for arrhythmia are used.[5]

See also


  1. ^ Jain, Anubhav; Yelamanchili, Varun S.; Brown, Kristen N.; Goel, Akshay (2024), "Holiday Heart Syndrome", StatPearls, Treasure Island (FL): StatPearls Publishing, PMID 30725870, retrieved 2024-02-15
  2. ^ "Holiday heart syndrome – definition".
  3. ^ Rosenthal L, Stokken GT, Smith RH, Daubert JP, Weiss HS, Budzikowski AS (17 October 2021). Talavera F, Compton SJ, Dizon JM (eds.). "Holiday Heart Syndrome: Background, Pathophysiology, Epidemiology". Medscape.
  4. ^ Ettinger PO, Wu CF, De La Cruz C, Weisse AB, Ahmed SS, Regan TJ (May 1978). "Arrhythmias and the "Holiday Heart": alcohol-associated cardiac rhythm disorders". American Heart Journal. 95 (5): 555–562. doi:10.1016/0002-8703(78)90296-x. PMID 636996.
  5. ^ a b c d e Tonelo D, Providência R, Gonçalves L (August 2013). "Holiday heart syndrome revisited after 34 years". Arquivos Brasileiros de Cardiologia. 101 (2): 183–189. doi:10.5935/abc.20130153. PMC 3998158. PMID 24030078.
  6. ^ a b Brown KN, Yelamanchili VS, Goel A (2022). "Holiday Heart Syndrome". StatPearls. Treasure Island (FL): StatPearls Publishing. PMID 30725870. Retrieved 2022-08-26.
  7. ^ Brunner S, Winter R, Werzer C, von Stülpnagel L, Clasen I, Hameder A, et al. (June 2021). "Impact of acute ethanol intake on cardiac autonomic regulation". Scientific Reports. 11 (1): 13255. Bibcode:2021NatSR..1113255B. doi:10.1038/s41598-021-92767-y. PMC 8225621. PMID 34168256.
  8. ^ Balbão CE, de Paola AA, Fenelon G (February 2009). "Effects of alcohol on atrial fibrillation: myths and truths". Therapeutic Advances in Cardiovascular Disease. 3 (1): 53–63. doi:10.1177/1753944708096380. PMID 19124390. S2CID 27879551.
  9. ^ Yan J, Thomson JK, Zhao W, Gao X, Huang F, Chen B, et al. (April 2018). "Role of Stress Kinase JNK in Binge Alcohol-Evoked Atrial Arrhythmia". Journal of the American College of Cardiology. 71 (13): 1459–1470. doi:10.1016/j.jacc.2018.01.060. PMC 5903584. PMID 29598867.
  10. ^ Sutanto H, Cluitmans MJ, Dobrev D, Volders PG, Bébarová M, Heijman J (September 2020). "Acute effects of alcohol on cardiac electrophysiology and arrhythmogenesis: Insights from multiscale in silico analyses". Journal of Molecular and Cellular Cardiology. 146: 69–83. doi:10.1016/j.yjmcc.2020.07.007. PMID 32710981. S2CID 220773275.
  11. ^ Mustroph J, Wagemann O, Lebek S, Tarnowski D, Ackermann J, Drzymalski M, et al. (March 2018). "SR Ca2+-leak and disordered excitation-contraction coupling as the basis for arrhythmogenic and negative inotropic effects of acute ethanol exposure". Journal of Molecular and Cellular Cardiology. 116: 81–90. doi:10.1016/j.yjmcc.2018.02.002. PMID 29410242.
  12. ^ Falcone AM, Schussler JM (October 2009). "Sudden atrial fibrillation associated with acute alcohol ingestion and cor triatriatum". Proceedings. 22 (4): 335–336. doi:10.1080/08998280.2009.11928550. PMC 2760166. PMID 19865505.
  13. ^ Wang Y, Morishima M, Li D, Takahashi N, Saikawa T, Nattel S, Ono K (October 2020). "Binge Alcohol Exposure Triggers Atrial Fibrillation Through T-Type Ca2+ Channel Upregulation via Protein Kinase C (PKC) / Glycogen Synthesis Kinase 3β (GSK3β) / Nuclear Factor of Activated T-Cells (NFAT) Signaling – An Experimental Account of Holiday Heart Syndrome". Circulation Journal. 84 (11): 1931–1940. doi:10.1253/circj.CJ-20-0288. PMID 33028764. S2CID 225072772.
  14. ^ Bhardwaj P, Chaudhury S (January 1996). "HOLIDAY HEART SYNDROME: A Case Report". Medical Journal, Armed Forces India. 52 (1): 61–62. doi:10.1016/S0377-1237(17)30840-7. PMC 5530300. PMID 28769342.
  15. ^ Rosenberg MA, Mukamal KJ (2012). "The Estimated Risk of Atrial Fibrillation Related to Alcohol Consumption". Journal of Atrial Fibrillation. 5 (1): 424. doi:10.4022/jafib.424 (inactive 31 January 2024). PMC 5153079. PMID 28496744.((cite journal)): CS1 maint: DOI inactive as of January 2024 (link)
  16. ^ "Learn the symptoms of Holiday Heart Syndrome and how to prevent it". Retrieved 2022-08-26.
  17. ^ LaMotte S (2019-12-12). "'Holiday heart syndrome': What is it and how to avoid it". CNN. Retrieved 2022-08-26.
  18. ^ Yang M, Barrios J, Yan J, Zhao W, Yuan S, Dong E, Ai X (February 2021). "Causal roles of stress kinase JNK2 in DNA methylation and binge alcohol withdrawal-evoked behavioral deficits". Pharmacological Research. 164: 105375. doi:10.1016/j.phrs.2020.105375. PMC 7867628. PMID 33316384.
  19. ^ a b Voskoboinik A, Prabhu S, Ling LH, Kalman JM, Kistler PM (December 2016). "Alcohol and Atrial Fibrillation: A Sobering Review". Journal of the American College of Cardiology. 68 (23): 2567–2576. doi:10.1016/j.jacc.2016.08.074. PMID 27931615. S2CID 205581782.
  20. ^ "What to Know About Holiday Heart Syndrome". Cleveland Clinic. 2021-12-03. Retrieved 2022-08-26.
  21. ^ Ul Abideen Z, Abbas SF, Farooq M, Rasheed A, Ali F (December 2016). "Acute Abdominal Aorta Thrombosis and Ischemic Rhabdomyolysis Secondary to Severe Alcohol Intoxication". Cureus. 8 (12): e905. doi:10.7759/cureus.905. PMC 5207781. PMID 28083449.
  22. ^ Engel TR, Luck JC (March 1983). "Effect of whiskey on atrial vulnerability and "holiday heart"". Journal of the American College of Cardiology. 1 (3): 816–818. doi:10.1016/S0735-1097(83)80195-8. PMID 6826972.

Further reading

  • Menz V, Grimm W, Hoffmann J, Maisch B (August 1996). "Alcohol and rhythm disturbance: the holiday heart syndrome". Herz. 21 (4): 227–231. PMID 8805002.
  • Alboni P, Gianfranchi L, Pacchioni F, Pedaci M (March 2005). "Antiarrhythmic drugs in patients with recurrent atrial fibrillation: where are we?". Italian Heart Journal. 6 (3): 169–174. PMID 15875505.