What is holiday heart syndrome (HHS)?

Updated: May 30, 2018
  • Author: Lawrence Rosenthal, MD, PhD, FACC, FHRS; Chief Editor: Jose M Dizon, MD  more...
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Answer

In 1978, Philip Ettinger and coinvestigators coined the term holiday heart syndrome (HHS) as "an acute cardiac rhythm and/or conduction disturbance associated with heavy ethanol consumption in a person without other clinical evidence of heart disease..." [1] The initial recognition of the syndrome was a result of their study evaluating 32 separate dysrhythmic episodes in 24 patients who were admitted to the hospital for their condition. [1] These patients consumed alcohol heavily and regularly; in addition, they took part in a weekend or holiday drinking binge immediately prior to evaluation. In their series, the most common cardiac rhythm disturbances were supraventricular tachyarrhythmias and atrial fibrillation. Typically, this resolved rapidly with spontaneous recovery during subsequent abstinence from alcohol use. [1]

It is relevant to note that chronic consumption of large quantities of alcohol (In the context of this article, alcohol refers specifically to ethanol) has long been recognized to induce an alcoholic cardiomyopathy. Clinically similar to idiopathic dilated cardiomyopathy, alcoholic cardiomyopathy is a major form of secondary dilated cardiomyopathy in the western world. (See the Medscape Drugs and Diseases articles Alcoholic Cardiomyopathy and Dilated Cardiomyopathy.) With this change in cardiac structure and decline in function, there exists the substrate for atrial and ventricular arrhythmias. [2]  

In the modern era, the term HHS has primarily been used to refer to acute cardiac rhythm disturbances related to acute alcohol consumption (ie, binge drinking), regardless of the underlying cardiac disease. [3] This is supported by the fact that the effect of alcohol on the induction of arrhythmias is dose dependent, and it is independent of preexisting cardiovascular diseases or heart failure. [4]   Even modest alcohol intake can be identified as a trigger in some patients with paroxysmal atrial fibrillation. [3, 5]  Although less rigorously studied, it should be noted that other substances associated with binge drinking certainly may contribute. As such, similar reports have indicated that recreational use of marijuana may have corresponding effects. [6]

The most common rhythm disorder with HHS is atrial fibrillation. [7, 8] HHS should be considered as a diagnosis in patients without structural heart disease and with new-onset atrial fibrillation. [9]


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