How that holiday drink could wreck your heart rhythm

Picture the scene: you’re sitting on a sun-baked terrace, overlooking the Mediterranean with a glass of red wine in your hand. You have another, and then possibly another. After all, you’ve worked hard for this holiday and the last thing on your mind is how many units of alcohol you’ve had.

But perhaps you should be counting. Research is now emerging to suggest that this kind of over-indulging on holiday could precipitate heart rhythm problems, leading to long-term complaints — it could even prove fatal.

The condition, known as Holiday Heart Syndrome, can affect otherwise healthy people of any age, although it appears to be more common in middle-age. And experts say people with more liberal attitude towards drinking generally, are particularly prone to it.

It’s not only holidays that put us at risk — experts now say that even weekend excesses can trigger the condition. And they’re not talking here about huge amounts of super-strength lager and falling down in the street. More and more people are abstaining from alcohol during the week, and binge-drinking on Friday and Saturday nights – and it doesn’t take much to ‘binge’.

In medical terms this is defined as a woman having more than six units in a short space of time — the equivalent of just two large glasses of wine. For a man it’s eight units (three pints of strong lager). ‘This is not a disease that affects only so-called lager louts; the middle classes are just as likely to be affected — if not more so because they are often career drinkers and in denial about what constitutes a binge,’ says consultant cardiologist Jonathan Clague from the Royal Brompton Hospital, UK.

He describes the problem as ‘a middle-class epidemic’. A typical Holiday Heart scenario, he explains, would be someone who abstains from alcohol during the working week then treats themselves to several large glasses of wine, beer or spirits in a single session over the weekend. This is often all it takes to trigger an abnormal heart rhythm.

With the alcohol coursing through their bodies, they may start to experience palpitations, breathlessness and sometimes light-headedness and chest pains. ‘The symptoms are very unpleasant,’ says Dr Clague.

‘Everyone reacts differently to an abnormal heart rhythm, but your heart rate may feel like it’s racing; you may feel light-headed and start to sweat. Many feel like they’re having a heart attack or about to die.’ Although the symptoms will usually disappear without medical treatment within 24 to 48 hours, they are likely to return after a subsequent binge and many of those affected will go on to develop a long-term irregular heartbeat (arrhythmia).

The most serious arrhythmia — and the most common with Holiday Heart Syndrome — is known as atrial fibrillation. This condition, results in erratic or extra electrical signals throwing off the normal timing of the heart’s rhythm, causing the heart to beat faster or quiver. When the heart fails to contract rhythmically, blood can pool in the chambers and form blood clots, which can clog arteries in the brain causing strokes. People with atrial fibrillation are twice as likely to suffer a stroke.

It’s not known how many cases of atrial fibrillation could be due to Holiday Heart Syndrome, but says Dr Clague, ‘alcohol is the single commonest cause in the structurally normal heart.’  

So how does alcohol cause this effect?

‘At the moment, the mechanism that causes Holiday Heart Syndrome is unknown, but the leading hypothesis is that adrenaline released when a person drinks a lot of alcohol has something to do with it,’ says California-based cardiologist Dr Arthur Klasky, who has carried out more than 60 studies investigating the relationship between alcohol and cardiovascular health. ‘Cases tend to peak over holiday periods, such as summer holidays and Christmas, as people tend to up their alcohol intake at these times.’
 
Dr Clague, however, believes the condition may simply be down to the poisoning effects of alcohol. ‘Alcohol directly poisons the heart muscle cells and causes permanent weakness,’ he says. ‘Most people know that alcohol causes liver damage but they don’t realise the damage it does to the heart. Anyone who experiences Holiday Heart should see their doctor, even if they don’t feel they need emergency treatment.’

Although there has been little research into Holiday Heart Syndrome, several studies have proven the link between heavy drinking and abnormal heart patterns. An international study carried out over 12 years and published in 2008 tested nearly 37,000 women and found that those who drank the equivalent of 14 alcoholic units a week — the maximum intake for women according to Government guidelines — were 60 per cent more likely to develop atrial fibrillation.

‘How many people think nothing of polishing off a bottle of wine at home in the evening? Yet the average bottle contains nine units,’ says Dr Clague. He warns of another high-risk group for Holiday Heart: if you exercise strenuously into middle age, you may think you’re off-setting the harmful effects alcohol has on the heart. But the opposite may be true. ‘The most common patient with atrial fibrillation is male, aged 40 to 55, who is still exercising hard, particularly running,’ says Dr Clague.
‘It’s not clear how exercise plays a part but it’s possible that strenuous exercise stretches the left atrium (which receives and pumps blood into the heart) and this combines with the poisoning effect of alcohol. ‘The best advice is listen to your body and keep alcohol consumption to a minimum. If you get an attack of palpitations then consult a doctor, and cut back on the alcohol and strenuous exercise.’

And when you are next sipping that wine on foreign shores, perhaps alternate it with a soft drink.