Holiday Heart Syndrome Clinical Presentation

Updated: May 30, 2018
  • Author: Lawrence Rosenthal, MD, PhD, FACC, FHRS; Chief Editor: Jose M Dizon, MD  more...
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Patients with acute exposure to alcohol can present with a variety of symptoms.

To reiterate, when holiday heart syndrome (HHS) is considered, alcohol-induced atrial fibrillation is generally what is implied. With that in mind, palpitations are the most common symptom when a patient presents to the hospital for atrial fibrillation. [1, 3] These can be intermittent or persistent, depending on the presence or absence of a sustained arrhythmia and the ventricular response to atrial fibrillation. Patients with rapid ventricular responses can present with near syncopal symptoms, dyspnea on exertion, fatigue, weakness, or angina.

Patients with HHS often have a history of previous alcohol exposure. This often occurs as binges on weekends, during vacations and, of course, on holidays. A history of alcoholism should alert physicians to concomitant illnesses such as alcohol-related cardiomyopathy and chronic liver disease. These coexisting illnesses have important prognostic implications and affect patient management.


Physical Examination

On physical examination, the patient with holiday heart syndrome may show signs of alcohol intoxication and have alcohol on the breath. Depending on the cardiac rhythm, the patient may have an irregular or thready pulse. Cardiac auscultation is usually normal, except for an "irregularly irregular" pulse. Mental status findings may be impaired, consistent with alcohol intoxication or hypotension if present.