Too much alcohol, especially during the holidays, can be bad for your heart.
With full social calendars and increased stress, it’s no surprise that people drink more during the holidays than any other time of the year. But those extra drinks can be hard on the body, and even lead to a condition called holiday heart syndrome.
Holiday heart syndrome typically occurs in people who do not have existing heart disease. But whether drinking too much alcohol triggers an isolated afib episode, or actually leads to new onset atrial fibrillation, depends on a lot of factors, says Rakesh Gopinathannair, MD, a cardiac electrophysiologist with the Kansas City Heart Rhythm Institute in Missouri.
“Afib is the most common heart rhythm disturbance, and high blood pressure, sleep apnea, and being 65 or older all factor in to whether or not a particular person who is drinking heavily will get these particular rhythm issues,” says Dr. Gopinathannair. He adds that it isn’t clear how common holiday heart syndrome is, since many people who experience the condition often don’t see a doctor.
One thing that is clear: Binge drinking, even on just one occasion, can trigger atrial fibrillation, a condition that’s been on the rise for decades. In the United States, at least three to six million people have afib. By 2030, more than 12 million Americans are expected to experience afib.
Because drinking is so embedded in American culture, the general population often doesn’t recognize the true effect that alcohol has on the body, says Kristen Brown, MD, an interventional cardiologist at Cardiology PC, a cardiac center in Birmingham, Alabama.
That's especially true for people with underlying heart disease, but alcohol takes a toll even on people without a history of cardiovascular disease.
Why Binge Drinking Triggers Atrial Fibrillation
What is considered “binge drinking”? According to the National Institute on Alcohol Abuse and Alcoholism, it’s drinking alcohol until your blood alcohol concentration is 0.08 percent or higher. For men, it’s having five or more alcoholic drinks in two hours, and for women, it’s having four.
But even one or two drinks will raise a person's blood alcohol level, which can impact the heart’s natural rhythm and increase the risk of holiday heart syndrome.
A study that included 100 participants, mostly white men with an average age of 64, found a strong correlation between even moderate alcohol use and atrial fibrillation. Researchers found that an afib event was associated with twofold higher odds of having consumed at least one drink in the four hours preceding the event and a more than threefold higher chance of having consumed at least two drinks in that time frame.
Because drinking isn’t the only lifestyle change that can happen at holiday time, it can be unclear if other factors may be driving afib episodes. In one study, alcohol’s role was confirmed when researchers looked at 446 people and examined several lifestyle factors that could trigger afib, including drinking caffeine, sleep deprivation, dehydration, eating large meals, exercise, laying on the left side of the body, and drinking alcohol.
Researchers found that alcohol was the only one that significantly increased a person’s risk for afib.
Here’s how alcohol interferes with heart function:
Disruption of Heart Cell Function When you drink heavily, alcohol affects the heart cells (called cardiac myocytes) and can cause an imbalance in calcium levels inside these cells. Calcium plays a key role in how the heart contracts and relaxes, but an episode of heavy drinking can cause too much calcium to build up during the phase when the heart should be resting. This can create extra electrical signals (called “after depolarizations”), which can trigger abnormal heart rhythms, like afib.
Impact on the Heart's Electrical System The heart has its own electrical system that keeps the rhythm steady. Alcohol can disrupt this system and cause the sympathetic nervous system (the fight-or-flight response) to become overactive and shorten the time the heart needs to recover between beats. This increases the chance that irregular heart rhythms will develop.
Dehydration and Electrolyte Imbalance. Alcohol is a diuretic, which means it can make you urinate more, and that can lead to dehydration. This can disturb the balance of minerals (electrolytes) like potassium and calcium, which help maintain the heart’s electrical stability. When these electrolytes are out of balance, it can make the heart fire off electrical signals at the wrong time, again increasing the risk of afib.
A person’s heart rate tends to be quite fast during an afib episode, between 150 and 200 beats per minute, says Gopinathannair. A normal resting heart rate is between 60 and 100 beats per minute.
But sometimes symptoms can also go unnoticed and lead to a big heart event later on, says Dr. Brown.
“During afib, blood is turbulent in the heart, and when that happens, the blood is more likely to clot. If a clot develops in the left side of the heart, it can travel to the brain, limbs, or organs and cause an ischemic stroke,” she says.
Factors that increase the risk of stroke in people with afib include:
Age 65 or older, with greater increased risk for ages 75 and over
Female
Diabetes
Heart failure
High blood pressure
History of stroke or heart attack
Peripheral arterial disease (PAD)
Treatment for Holiday Heart Syndrome
To address holiday heart syndrome, Gopinathannair says to avoid drinking immediately.
“Once you abstain from alcohol, basically treatment would be hydration and getting electrolytes. The majority of the cases of atrial fibrillation during holiday heart syndrome stop on their own, but there is always the risk of future episodes,” he says.
Doctors may also try cardioversion, a treatment that uses quick, low-energy shocks to restore a person’s heart rhythm. It can also be done using medicines.
Treatments to Lower Stroke Risk
People with untreated afib are much more likely to have a stroke than people without afib. For this reason, some people may be put on blood thinners, says Brown.
Afib increases the risk of clotting, and blood thinners help prevent clot formation.
“One episode of atrial fibrillation also puts you at a higher risk for recurrent afib, which then puts you at a higher risk for heart failure,” she says.
For people with recurrent afib, a procedure called an ablation may be considered. An ablation is performed with a small wire to burn or freeze tissue inside the heart to break up irregular electrical signals. It’s usually only considered if afib persists despite treatment, or if a person doesn’t want to take medication long term.
How to Avoid Holiday Heart Syndrome
With a little planning, you can avoid holiday heart syndrome and still enjoy the holidays.
Here are a few tips to keep your heart healthy:
Limit your drinking. Abstaining from alcohol, especially if you already have an underlying heart issue, is the best way to avoid holiday heart syndrome.
If you don’t think you can abstain from alcohol, try to limit your drinking. Experts recommend no more than one drink a day for women and two for men on days when alcohol is consumed, which shouldn’t be every day. But even staying within those limits may increase the risk of dying from certain cancers and cardiac disease.
Don’t take medications that contain stimulants. Medicines that contain stimulants, including over-the-counter cold and allergy medicines should be avoided. Ask your pharmacist for recommendations for non-stimulant-containing medications.
“People aren’t going to completely give up drinking, but excessive amounts of alcohol can have big effects on the brain, kidneys, and heart,” says Brown. To put your best holiday heart forward, she says, “The main lesson here is just to limit alcohol use.”
Even one episode of heavy drinking can trigger holiday heart syndrome, leading to atrial fibrillation (afib), an irregular heartbeat, and potential long-term heart complications.
People who have afib that doesn’t resolve on its own may require hospitalization, taking blood thinners, or even procedures like ablation.
Reducing alcohol intake, limiting fatty and processed foods, and staying hydrated can significantly reduce the risk of developing holiday heart syndrome.
