Holiday heart syndrome

Kirstie Louise Alley is an American actress, comedian and spokes model. News of her death spread quickly last week causing concern among fans across the world. However, the earlier December 2017 report has now been confirmed as a complete hoax and just the latest in a string of fake celebrity death reports. Thankfully, the actress best known for her roles in “Cheers” or “Look Who's Talking” is alive.  She allegedly wrote, “I binge on alcohol when I'm happy, when everything is going really well, also when things are not going well. Every day to me is like I'm at a birthday party.” A rather reckless utterance, isn’t it?

Last Monday, a middle-aged affable gentleman presented himself to my clinic in Margão with history of pressure in the chest and severe palpitation. He had had an alcoholic binge on the previous night. 

Presto, I took an ECG which showed “paroxysmal atrial fibrillation” and the Echocardiogram, done in quick succession, revealed no structural heart disease. As my erstwhile Hospital, Holy Spirit Nursing Home, after years of yeoman service is now closed for good, I asked a respected colleague of mine to get him admitted to another Hospital under his expert supervision for further observation and management. 

Mercifully, soon after entering the Hospital, even before any treatment was started, my phlegmatic patient reverted to normal sinus rhythm and was discharged on the next day with the stern advice to abstain from alcohol … with the diagnosis of “Holiday Heart Syndrome” (HHS).

“Holiday heart syndrome” is an irregular heartbeat pattern which develops in individuals who are otherwise healthy. It is usually a temporary "abnormal heart rhythm” following excessive alcohol consumption on weekends. 

Irregular heartbeats can be serious. If palpitations continue for longer than a few hours, patients should seek medical attention. Some arrhythmias associated with HHS after binge drinking can lead to sudden death, which may explain some of the sudden death cases commonly reported in alcoholics. “Atrial fibrillation” is the most common arrhythmia in holiday heart syndrome. Symptoms usually resolve within 24 hours.

What is “atrial fibrillation?” Normally, your heart contracts and relaxes to a regular beat. Certain cells in your heart make electric signals that cause the heart to contract and pump blood. These electrical signals show up on an electrocardiogram (ECG) recording. Your doctor can read your ECG to find out if the electric signals are normal. 

In “atrial fibrillation” the heart’s two small upper chambers (atria) don’t beat the way they should. Instead of beating in a normal pattern, the atria beat irregularly and too fast, quivering like a bowl of gelatin. It’s important for the heart to pump properly so your body gets the oxygen and food it needs.  “Atrial Fibrillation”, if prolonged, can lead to blood clots, stroke, heart failure and other heart-related complications

An association between the acute ingestion of alcohol and onset of cardiac arrhythmias was first reported in the early 70's and in 1978  Philip Ettinger described "Holiday heart syndrome" (HHS) for the first time, as the occurrence in healthy people without heart disease of an acute cardiac rhythm disturbance after binge drinking. 

The name is derived from the fact that episodes are observed more frequently after weekends or public holidays. 

It is important to note that patients with HHS are apparently healthy, with no personal or family history of palpitations or other suggestive symptoms of structural cardiac anomalies or any clinical evidence of heart disease. Laboratory and other tests are usually normal and once the bout subsides the electrocardiogram reverts to normal.

Another particular characteristic of HHS is the lack of new episodes with alcohol abstinence and the recurrence of symptoms with continued alcohol abuse. 

This observation further strengthens the role of alcohol in the development of these arrhythmias and also the importance of avoiding alcohol binging to prevent the occurrence of new events. During admission of a patient with palpitations associated with cardiac arrhythmias, a high suspicion of HHS should occur if the patient has had a recent episode of binge drinking. After confirming the cardiac arrhythmia and excluding evident heart diseases, the physician should explain the syndrome to the patient and recommend alcohol abstinence in an effort to prevent new episodes of HHS.

What advice in general should doctors give to the sufferers in order to help the heart survive holiday cheer? Here are some simple guidelines:-If you are a party animal please watch your alcohol intake. Don’t overeat. Stay calm and avoid stress. Avoid excessive salty food. 

Limit additional caffeine intake. Stay hydrated by drinking plenty of water throughout the day. If you are a heavy cigarette smoker or marijuana addict, be doubly careful.

Despite all cautionary advice about alcohol drinking here’s some happy news: Cheers, say scientists! Drinking does release the “feel-good factor” in our brains.  Rush of chemicals after drinking produce feelings of pleasure and reward in an area of the human brain often referred to as the 'pleasure centre'. 

Let me confess that some of the best moments I’ve spent have been over a glass or two of Scotch chatting with close friends. But there’s always a prayer on my lips, “Lord, whenever I eat or drink help me not to be brought under the power of any vice and to be slave to none”.

(Dr Francisco Colaço is a seniormost consulting physician, pioneer of Echocardiography in Goa, column writer and singer/songwriter/music 

aficionado)