Holiday Heart Syndrome Medication

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

Medication Summary

Symptoms of acute alcohol toxicity often resolve spontaneously. Arrhythmia monitoring and observation are adequate in many patients. In patients with atrial tachyarrhythmias and a rapid ventricular response (eg, atrial fibrillation or flutter), ventricular rate control is important for those who are symptomatic. The use of intravenous beta-antagonists, diltiazem, or verapamil is appropriate. Digoxin has a slow onset of action, and chronic therapy with this drug is rarely indicated. As always, patients who are hemodynamically unstable patients should be treated with direct current cardioversion.

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.

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.

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Beta-antagonists

Class Summary

In patients with atrial tachyarrhythmias and a rapid ventricular response (eg, atrial fibrillation or flutter), ventricular rate control is important for those who are symptomatic.

Metoprolol (Lopressor, Toprol XL)

Beta-antagonists are useful agents because of their rapid onset of action and sympatholytic effects. They are the treatment of choice if acute myocardial ischemia or myocardial infarction is present.

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Calcium channel blockers (nondihydropyridine)

Class Summary

In specialized conducting and automatic cells in the heart, calcium is involved in the generation of the action potential. The calcium channel blockers inhibit movement of calcium ions across the cell membrane, thus depressing both impulse formation (automaticity) and conduction velocity.

Verapamil (Calan, Covera-HS, Verelan)

Can diminish PVCs associated with perfusion therapy and decrease the risk of ventricular fibrillation and ventricular tachycardia.

Diltiazem (Cardizem CD, Dilacor, Tiazac)

For symptomatic supraventricular tachycardias. In many situations, this may be the drug of choice if used IV, since it is relatively short acting and can be stopped if there is resolution of arrhythmia following recovery from acute alcohol toxicity. This is an excellent approach in patients without evidence of underlying cardiac disease.

Digoxin (Lanoxin, Lanoxicaps)

Cardiac glycoside with direct inotropic effects in addition to indirect effects on the cardiovascular system. Acts directly on cardiac muscle, increasing myocardial systolic contractions. Its indirect actions result in increased carotid sinus nerve activity and enhanced sympathetic withdrawal for any given increase in mean arterial pressure.

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