Have you ever had an ache in your chest after a night of heavy drinking, perhaps over the holidays? Or maybe you even felt it a few hours after a binge-drinking session. If this sounds familiar, you may have a serious problem. While getting chest pain after alcohol consumption is not something that everyone experiences, it is more common than you think. Although not a defined condition, some doctors have labelled the irregular heart beat, breathlessness, or chest pain after alcohol as “holiday heart syndrome”.
The British Medical Journal reported that in the UK Sunday-night into Monday morning is the commonest time of the week for heart deaths and linked this to weekend binge drinking(1).
Before diagnosing chest pain as due to the heart, doctors will of course also consider whether it might be arising in the oesophagus (‘gullet’) and stomach – which might also be related to alcohol from alcohol-irritation – or strain in one of the rib muscles. Some heavy drinkers get inflammation of the pancreas which can cause pain felt in the ribs as well as the tummy.
But there is no doubt that heavy drinking causes some serious and common heart problems.
How Alcohol Affects the Heart
Alcohol, even in healthy individuals, can increase blood pressure and may cause an irregular heart beat (atrial fibrillation), and episodes of these are often noticeable during hangovers and withdrawals.
Heavy drinking over many years can cause the heart muscle to expand which weakens it and causes it to work less efficiently.
Isn’t Alcohol Good for the Heart?
While there are studies that have found that people drinking very low amounts of alcohol tend to have lower blood pressure and fewer heart attacks, these also tend to be the people who take more exercise, have stable lives and better diets, any or all of which could explain the link. Nevertheless, scientists have shown that moderate drinking tends to balance cholesterol levels and reduce blood clotting which together could help prevent arteries getting narrowed.
However, any possible alcohol-related health benefits apply only for people who drink very moderately. Most of the time, if someone experiences heart problems from drinking, they are drinking significantly more than the 14 drinks (i.e. about 140 grams of ethanol) per week which public health specialists put as the recommended ceiling.
Why You May Have Chest Pain After Alcohol
Alcohol-related chest pain can be caused by a number of reasons. If it’s heart-related, it may be angina (reduced blood flow to the heart) or, as a worst-case scenario, a heart attack. It may also signify the presence of a pre-existing condition, which was triggered by alcohol consumption. There are many conditions that are caused or aggravated by alcohol. However, they may also be unrelated to one’s alcohol intake.
The expansion and weakening of the heart puts extra pressure on surrounding blood vessels which results in ‘alcohol cardiomyopathy’ (disease of the heart muscle) and often presents itself as chest pain. This condition seems to be a cumulative effect from years of heavy drinking. It can lead to ‘heart failure’ where fluid accumulates in parts of the body because the pumping of the heart is diminished.
Cardiomyopathy has various causes, and alcohol is only one of them. However, alcohol may worsen cardiomyopathy that is present due to other reasons.
An allergic reaction can present itself in multiple ways, two of which, breathlessness and chest pain, resemble a heart attack. If a person has chest pain specifically after drinking, they may have an allergic reaction to alcohol itself or one of the ingredients present in the drink.
Some alcohol can be good for digestion, but large amounts can have the opposite effect and trigger acid reflux. The symptoms of acid reflux include discomfort or pain in the upper body and can even be mistaken for a heart attack. This is even more likely if a person eats a large meal at the same time, which isn’t rare after one has a lot to drink.
Along with a bad diet and genetic predisposition, pancreatitis can be caused by long-term alcohol abuse. An acute pancreatitis attack is extremely painful and can radiate to the upper chest, although it is usually felt in the abdominal area or lower back.
Stress and Anxiety
Excessive drinking can worsen anxiety levels, partly because of the rebound in the nervous system that follows during the morning after. Some people even have panic attacks after a night of heavy drinking, which can lead the sufferer to fear that a heart attack is going to happen.
You may get muscle aches from just working out or a heavy night of partying, but they become more noticeable after drinking. This is due to dehydration and electrolyte imbalance from alcohol.
It is not exactly known why, but chest pain after alcohol may signify the presence of cancer. Specifically, lymphoma. It is theorised that alcohol increases blood flow to lymph nodes causing pain which radiates to the chest.
If someone is taking other medications or drugs, the interaction can result in chest pain as well. If alcohol is mixed with cocaine, it puts a lot of strain on the cardiovascular system. Metronidazole, an antibiotic, can worsen high blood pressure when taken with alcohol.
Smoking alone can irritate the lungs, which may cause chest pain, but combined with alcohol can also increase blood pressure. In addition, smoking tends to worsen symptoms of acid reflux.
What to Do If You Experience Alcohol Chest Pain
Chest pain shouldn’t be ignored. If you feel unwell after drinking, and it doesn’t improve with rest and perhaps an anti-acid if you are prone to indigestion, then ask for advice. Depending on how severe it is, if it doesn’t improve medical opinion should be requested.
Know the Symptoms of a Heart Attack
Because alcohol can trigger a heart attack, it is important to know the signs. Some people tend to dismiss chest pain, which can be dangerous. In addition, the symptoms may not always be present or as extreme, especially in women. However, if any of the following major symptoms last for more than 15 minutes, it is better to go to a hospital.
- Severe chest pain (crushing, tight, or heavy pressure)
- Radiating pain to other parts of the body (shoulders, arms, back)
- Difficulty breathing
How to Prevent Alcohol Chest Pain
A healthy diet and regular exercise can help prevent heart disease . Do not overeat..
If you notice that you get regular chest pain after drinking, you should moderate your intake or stop altogether. Because it may signify the presence of a different problem, it is important to talk to a doctor. And if you feel that you can’t limit yourself or stop, you may be developing alcohol ‘dependence i.e. addiction.
Addiction is a progressive disease but a treatable one. Should you notice any signs in yourself or anyone you know, there is help: AA meetings, your GP, or even a residential centre (‘rehab’).
Castle Craig specialises in all types of addiction, and has treated thousands of people addicted to alcohol and drugs. If you think you have a problem, don’t hesitate to give us a call. Our consultants will can give you advice and guidance without any obligation.
Laurent Chenet, Annie Britton
BMJ 2001; 322: 998