Co-occurring Signs and Symptoms
Many of us will experience anxiety symptoms at some point. Unfortunately, the same symptoms that are indicative of anxiety can also mimic heart conditions such an irregular heartbeat. For example, a panic attack either occurs without warning or in response to a stressful event but it is not life-threatening. However, a heart attack is, and requires immediate medical assessment and care.
Approximately five percent of adults in the general population meet the criteria for generalized anxiety disorder but this incidence higher in those with coronary artery disease or congestive heart failure respectively. Up to 13 in 100 people with heart disease also suffer from an anxiety disorder. This may result from a variety of factors, such as increased or abnormal heart rate or blood pressure issues, for example.
Panic attacks and heart attacks can display the same frightening symptoms:
Shortness of breath or shallow breathing
Palpitations or feeling “jittery”
Chest pain or tightness
Dizziness or light-headedness
Dissociation or detachment
Altered sensation in hands and feet such as numbness or “pins and needles”
Anxiety and panic symptoms are normal, adaptive, protective responses. In practical terms, they quickly elevate your heart rate and expand the blood vessels to enable blood to flow quickly and you to move fast; and cortisol is produced by the adrenal glands in the “fight-or-flight” process. However anxiety puts stress on the heart and chronic stress or anxiety leads to elevated cortisol levels, which have been shown to elevate blood pressure and increase the risk of heart disease, as well as continuing to raise (or maintain already high) anxiety levels.
Problems diagnosing anxiety disorders in people with cardiovascular disease
Diagnosing anxiety disorders in those with cardiovascular disease is difficult owing to the considerable overlap between the symptoms of both conditions. If the overlapping symptoms are focused upon too heavily, there may be the risk of attributing cardiac symptoms to anxiety. For example, it is common that in women, heart symptoms are diagnosed as anxiety whereas doctors tend to see older males as having risk factors. Women are also treated less aggressively in health response terms when initially encountering the healthcare system; perhaps part of the notion that women are neurotic and men, stoic.
Researchers have found a connection between anxiety and the heart, but, in comparison with the link between depression and heart disease, it isn't understood as well. Whilst stress and anxiety are often found to be associated with an increased risk of cardiovascular problems (and a heart event can also cause anxiety), the cyclical pattern renders it extremely difficult to ascertain where each disorder sits in the process. So, anxiety can be part of the picture of cardiovascular disease, but ironically it can be a cause, as well.
Anxiety as a predictor of heart disease
Anxiety disorders have already been found to contribute to the development of heart disease and coronary events in people with current heart disease. Among patients with cardiovascular disease, anxiety and formal anxiety disorders are common and associated with poor cardiovascular health. One study found that women with severe phobic anxiety were nearly 60 percent more likely to have a heart attack, and approximately 30 percent more likely to die as a result than those with the lowest anxiety levels. Furthermore, data from 3,300 postmenopausal women showed that a panic attack history tripled the risk of a coronary event or stroke.
Several other studies have concluded that in those with established heart disease (men and women), those suffering from an anxiety disorder were twice as likely to experience a cardiac event in comparison with those with anxiety disorder history.
Anxiety with heart disease
Having a life-threatening condition is understandably going to change your world view and increase your sense of vulnerability. It might lead to a sense of impending danger or doom and a feeling of being out of control; such feelings might cause an anxiety disorder to develop.
Tachycardia can cause anxiety
Abnormal heart rhythms (from the upper heart chambers) in excess of 100 beats per minute are called supraventricular tachycardias (SVTs). These can occur in healthy hearts as well as in those who've previously had heart problems. In most people, they are random and not brought on by exercise and cause symptoms of heart palpitations, light-headedness, discomfort in the chest, altered breathing, and can cause an individual to pass out. If someone experiences such events, they respond cognitively which can lead to further symptoms of anxiety and panic.
SVTs are a good example of how anxiety can result from a cardiac event, when it was previously never present. The fear of having another attack can be crippling. Indeed, a reasonable response to a sudden heart attack can be similar to post-traumatic stress disorder:
A major medical event such as one that might be interpreted as “near-death” is likely to be experienced as extremely shocking and make the person hesitant to do the things they formerly did.
The event may be frequently relived, and the person may avoid the activity or place associated with the experience.
Recurrent thoughts may impact their ability to sleep.
Thoughts about the future negative are likely to take a negative tone and the person may have a sense of impending mortality.
Treatment for people who have had a heart attack and also have a panic attack
For someone who has had a heart attack and also has panic attacks, they and their physician should work to identify the symptoms that should trigger the need for assessment as to whether it is anxiety or not, they always need to be treated as signs of a possible heart attack. Together they can work to distinguish what may be anxiety or heart related, which is likely to be specific to them.
Those who have never experienced a cardiac event but have a diagnosis of anxiety or panic disorder and fear having a heart attack need to have their heart health assessed to determine appropriate treatment. If they are not at risk of a heart attack, then they know to work on their symptoms psychologically.