William P. Shutze, MD, is a vascular surgeon at Texas Vascular Associates in Dallas and Plano, Texas, and an executive board member of the Society for Vascular Surgery. He is board-certified in vascular surgery, general surgery, and surgical critical care, with a professional focus on aortic and peripheral vascular disease.

In this Q&A with Medscape Medical News, Shutze discussed Holiday Heart Syndrome, the vascular risks associated with seasonal behaviors, and preventive strategies primary care physicians (PCPs) can use to protect their patients.

What is Holiday Heart Syndrome, and what typically triggers it in patients?

After noticing an increase in irregular heartbeats, also called atrial fibrillation (AF), in December and January, researchers coined the term Holiday Heart Syndrome to describe an increase in AF that can occur following a period of increased drinking, usually more than five to six standard drinks in a short period. However, combined with high-sodium foods, elevated stress levels, and decreased exercise present during the holiday season, binge drinking can harm the blood vessels running to and from your heart, or your vascular system.

What signs of vascular disease should PCPs never ignore?

PCPs should be vigilant for symptoms that signal impaired circulation or an impending vascular event, even when patients attribute them to “holiday fatigue.” Alert your patients of red flags including new leg pain or cramping when walking, nonhealing wounds on the feet or toes, sudden coldness or color changes in the limbs, and abrupt numbness, tingling, or weakness in the lower extremities. 

Chest pain, shortness of breath, palpitations, and sudden swelling in the legs should also never be overlooked, as they may reflect vascular complications like AF linked to Holiday Heart Syndrome. New or worse leg swelling is very important as it may be a sign of a blood clot or heart failure. Ahead of the holidays, make sure to alert your patients of these symptoms to prevent unwanted health consequences.

How do holiday behaviors — like heavy meals, high sodium, fatty foods, and increased alcohol — affect the vascular system?

They can strain the vascular system in several ways. Large, high-sodium, and high-fat meals can cause spikes in blood pressure (BP) and stiffen blood vessels, affecting blood circulation, clot formation, and plaque buildup. Alcohol adds another layer of stress to the body through dehydration, raising heart rate and BP, and disrupting regular heartbeat patterns. Dehydration increases the risk for blood clots in both the arteries and veins. When combined for multiple days in a row, fatty foods and alcohol can significantly increase the likelihood of vascular events like blood clots and stroke. Especially in patients with known peripheral vascular disease.

Stress levels often rise during the holidays. How important is stress management and maintaining exercise, and what practical guidance can PCPs give patients?

PCPs can educate and encourage patients by recommending simple routines such as:

• Walk 10-15 minutes after big meals — helps glucose control, lowers BP, and improves endothelial function
• Aim for ≥ 5000 steps/d even if you can’t get to the gym
• Alternate alcoholic drinks with water; set a firm limit (eg., ≤ 2 drinks/d for men, ≤ 1 for women)
• Practice 4-7-8 breathing or 5-minute mindfulness breaks when tensions rise — proven to blunt BP surges
• Prioritize sleep — aim for consistent bed/wake times; poor sleep is an independent AF trigger
• “If you wouldn’t eat or drink it in July, think twice in December”

Small, consistent habits beat heroic New Year’s resolutions. Encouraging patients to set realistic goals and track movement can help them stay active without feeling overwhelmed, reinforcing that small, consistent habits go a long way in protecting their vascular health this time of year.

Are there particular patient populations you worry about most during this time?

Individuals who are older than 65 years, have high BP, diabetes, metabolic syndrome or obesity may be at greater risk. Additionally, patients with preexisting AF and known atherosclerotic disease (coronary artery disease, peripheral artery disease, cerebrovascular disease). Patients on anticoagulants who drink heavily are at risk for falls and intracranial hemorrhage. These groups should consider limiting their alcohol and salt intake during the holidays.

What advice do you have for PCPs on counseling or preventive strategies before patients get to the point of an emergency room visit?

Whether your patients are in the at-risk population or not, it’s important to stress the importance of managing alcohol consumption over the holiday season. Easy strategies like exercise, reducing stress, and opting for a glass of water instead of wine may help reduce your patient’s chances of developing serious health conditions, such as AF or vascular complications. Set a drinking limit in advance and stick to it (write it down). One extra walk and one glass of water between drinks can prevent an ambulance ride. Take all BP, diabetes, and heart medications even when traveling and pack extra in case of travel delays and stay well hydrated.