Holiday Heart Syndrome Differential Diagnoses

Updated: Aug 31, 2017
  • Author: Adam S Budzikowski, MD, PhD, FHRS; Chief Editor: Jose M Dizon, MD  more...
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Diagnostic ConsiderationsImportant considerations

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 reoccur.

Consider medicolegal issues related to the management of patients with acute and/or chronic problems related to alcohol.

Other considerations in patients with suspected holiday heart syndrome is the excessive use of caffeine or over-the-counter decongestants (eg, ephedrine, phenylpropanolamine [recalled from US market]).

Differential Diagnoses