eMedicine Specialties > Cardiology > Arrhythmias

Holiday Heart Syndrome: Follow-up

Author: Adam S Budzikowski, MD, PhD, Assistant Professor of Medicine, Division of Cardiovascular Medicine, Electrophysiology Section, State University of New York-Downstate, University Hospital of Brooklyn
Coauthor(s): James P Daubert, MD, Associate Professor of Medicine, Director of Electrophysiology Service, University of Rochester Medical Center; Consulting Staff, Atrial Fibrillation Clinic and Adult Congenital Heart Clinic, University of Rochester Medical Center, Strong Memorial Hospital; Richard H Smith, MD, Director of Echocardiography, Long Island Heart Associates, State University of New York at Stony Brook; Clinical Assistant Professor, Department of Cardiology, Winthrop-University Hospital and North Shore University Hospital; Howard S Weiss, DO, Staff Physician, Department of Medicine, Winthrop University Hospital
Contributor Information and Disclosures

Updated: Apr 21, 2009

Follow-up

Further Inpatient Care

Upon resolution of holiday heart symptoms and return to sinus rhythm, treadmill stress testing is reasonable in some patients to look for exercise-related arrhythmia when the acute effects of alcohol have resolved. This is also important in patients at risk for coronary artery disease; occasionally, additional cardiac imaging (eg, perfusion imaging, echocardiography) is required.

Further Outpatient Care

Alcohol-induced atrial fibrillation without other unrelated episodes would not typically be considered a current indication for atrial fibrillation surgical or catheter ablation.

Inpatient & Outpatient Medications

Upon resolution of the alcohol-related arrhythmia, most patients do not require further therapy if they refrain from alcohol use. Patients with underlying heart disease or those with severe symptoms on presentation (eg, syncope, hypotension) may be candidates on discharge for oral agents such as beta-antagonists.

Transfer

Persons with alcoholism should be considered for transfer to facilities for detoxification/rehabilitation.

Deterrence/Prevention

Advise patients to refrain from alcohol and stimulants and to avoid excessive fatigue.

Prognosis

Prognosis depends on the presence of underlying heart disease. Long-term alcohol use increases the risk of cardiomyopathy and chronic liver disease.

Miscellaneous

Medicolegal Pitfalls

  • Although long-term anticoagulation is indicated for patients with paroxysmal, persistent, or permanent atrial fibrillation and risk factors for thromboembolism, physicians should be cautious about anticoagulating patients with expected acute alcohol toxicity, especially if there is a history of possible trauma. A reasonable approach may be to provide short-term anticoagulation with heparin in the presence of risk factors for thromboembolism (eg, previous stroke, hypertension, congestive heart failure, diabetes, age >65-75 y), as long as there are no contraindications, while ascertaining risk factors for embolic events in the setting of atrial fibrillation (CHADS score). Some patients are candidates for long-term anticoagulation with warfarin.
  • Many elderly patients, or those with structural heart disease, develop atrial fibrillation. A history of recent alcohol use at times can be coincidental in these patients. Physicians should not mistakenly avoid anticoagulation under the assumption that atrial fibrillation will not recur.
  • Medicolegal issues related to the management of patients with acute and/or chronic problems related to alcohol should be considered.
  • Many elderly patients, or those with structural heart disease, develop atrial fibrillation. A history of recent alcohol use at times can be coincidental in these patients. Physicians should not mistakenly avoid anticoagulation under the assumption that atrial fibrillation will not reoccur.
  • Medicolegal issues related to the management of patients with acute and/or chronic problems related to alcohol should be considered.
 


More on Holiday Heart Syndrome

Overview: Holiday Heart Syndrome
Differential Diagnoses & Workup: Holiday Heart Syndrome
Treatment & Medication: Holiday Heart Syndrome
Follow-up: Holiday Heart Syndrome
References
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References

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Further Reading

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Keywords

holiday heart syndrome, short-term alcohol consumption, alcohol-related paroxysmal atrial fibrillation, acute cardiac alcohol toxicity, arrhythmia, holiday heart symptoms, holiday heart treatment, holiday heart causes, alcohol-related cardiomyopathy, idiopathic dilated cardiomyopathy, dysrhythmic episodes, acute cardiac rhythm disturbance, acute conduction disturbance, supraventricular tachyarrhythmia, binge, binge drinking

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Contributor Information and Disclosures

Author

Adam S Budzikowski, MD, PhD, Assistant Professor of Medicine, Division of Cardiovascular Medicine, Electrophysiology Section, State University of New York-Downstate, University Hospital of Brooklyn
Adam S Budzikowski, MD, PhD is a member of the following medical societies: American College of Cardiology, European Society of Cardiology, Heart Rhythm Society, and Polish Society of Cardiology
Disclosure: Nothing to disclose.

Coauthor(s)

James P Daubert, MD, Associate Professor of Medicine, Director of Electrophysiology Service, University of Rochester Medical Center; Consulting Staff, Atrial Fibrillation Clinic and Adult Congenital Heart Clinic, University of Rochester Medical Center, Strong Memorial Hospital
James P Daubert, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Cardiology, American Heart Association, and Heart Rhythm Society
Disclosure: Medtronic Equity interest None; Boston Scientific Honoraria Speaking and teaching; CV Therapeutics Consulting fee Consulting; Cryocor Consulting fee Consulting

Richard H Smith, MD, Director of Echocardiography, Long Island Heart Associates, State University of New York at Stony Brook; Clinical Assistant Professor, Department of Cardiology, Winthrop-University Hospital and North Shore University Hospital
Richard H Smith, MD is a member of the following medical societies: American College of Cardiology, American College of Physicians-American Society of Internal Medicine, and American Medical Association
Disclosure: Nothing to disclose.

Howard S Weiss, DO, Staff Physician, Department of Medicine, Winthrop University Hospital
Howard S Weiss, DO is a member of the following medical societies: American Medical Association and American Osteopathic Association
Disclosure: Nothing to disclose.

Medical Editor

Hanumant Deshmukh, MD †, Former Chief of Cardiology, Veterans Affairs Medical Center; Former Associate Professor, Department of Medicine, Rosalind Franklin University of Medicine and Science
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Steven J Compton, MD, FACC, FACP, Director of Cardiac Electrophysiology, Alaska Heart Institute, Providence and Alaska Regional Hospitals
Steven J Compton, MD, FACC, FACP is a member of the following medical societies: Alaska State Medical Association, American College of Cardiology, American College of Physicians, and Heart Rhythm Society
Disclosure: Nothing to disclose.

CME Editor

Amer Suleman, MD, Consultant in Electrophysiology and Cardiovascular Medicine, Department of Internal Medicine, Division of Cardiology, Medical City Dallas Hospital
Amer Suleman, MD is a member of the following medical societies: American College of Physicians, American Heart Association, American Institute of Stress, American Society of Hypertension, Federation of American Societies for Experimental Biology, Royal Society of Medicine, and Society of Cardiac Angiography and Interventions
Disclosure: Nothing to disclose.

Chief Editor

Jeffrey N Rottman, MD, Professor of Medicine and Pharmacology, Director, Clinical Cardiac Electrophysiology Fellowship Program, Vanderbilt University School of Medicine; Chief, Department of Cardiology, Nashville Veterans Affairs Medical Center
Jeffrey N Rottman, MD is a member of the following medical societies: American Heart Association and North American Society of Pacing and Electrophysiology (NASPE)
Disclosure: Nothing to disclose.

 
 
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