Anxiety and heart
Anxiety and Heart Disease | Johns Hopkins Medicine
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The association between anxiety and heart disease has not been as fully studied as the relationship between depression and heart disease.
However, Una D McCann, M.D., director of the Anxiety Disorders Program at Johns Hopkins Bayview Medical Center, believes the connection is strong.
Anxiety and the Development of Heart Disease
“It’s my view and my personal clinical experience that anxiety disorders can play a major role in heart disease,” says McCann. “I believe that a really careful look at anxiety would reveal the ways it can severely impact heart disease, both as a contributing factor and as an obstacle in recovery.”
A natural reaction to a sudden heart attack can be similar to post-traumatic stress disorder:
- You’re likely to be shocked by your near-death experience and extremely hesitant to do the things you used to do.
- You might constantly relive the life-threatening event, and avoid the activity or place associated with the heart attack.
- Recurring anxious thoughts may impede your ability to get regular sleep.
- Your thoughts about what lies ahead may be extremely negative and cause a drastically foreshortened outlook of the future.
The Effect of Anxiety on the Heart
When someone is anxious, their body reacts in ways that can put an extra strain on their heart. The physical symptoms of anxiety can be especially damaging among individuals with existing cardiac disease.
Anxiety may have an association with the following heart disorders and cardiac risk factors:
- Rapid heart rate (tachycardia) – In serious cases, can interfere with normal heart function and increase the risk of sudden cardiac arrest.
- Increased blood pressure – If chronic, can lead to coronary disease, weakening of the heart muscle, and heart failure.
- Decreased heart rate variability – May result in higher incidence of death after an acute heart attack.
Anxiety and Heart Attack Recovery
Anxiety disorders come with a high degree of fear and uncertainty. When this fear and certainty keeps the heart attack or heart disease patient from following the advice and treatment plan of their cardiologist, it can have a major impact on recovery. Anxiety can interfere with:
- Sticking to prescribed exercise regimens
- Taking prescribed medications
- Following through with a healthy diet
- Getting a proper amount of quality sleep
- Reconnecting with friends and family
- Confidently resuming job career and family responsibilities
Different Types of Anxiety Disorder
Anxiety disorders fall into several categories. Here are a few of them:
- Panic disorder – can be associated with cardiac disease or mistaken for heart attack.
Feelings of extreme agitation and terror are often accompanied by dizziness, chest pains, stomach discomfort, shortness of breath, and rapid heart rate. - Post-traumatic stress disorder (PTSD) – a condition that can follow a shocking or frightening incident or sudden, life-threatening event such as a violent crime, major accident, or heart attack. A person suffering from PTSD often has trouble dealing with anything associated with the incident that caused their condition, and experiences feelings of jitteriness and detachment.
- Obsessive-Compulsive disorder – People with OCD will manage unreasonable thoughts and worries by performing the same actions over and over. For example, an individual obsessed with perceived cardiovascular symptoms that have been checked and cleared by a physician may compulsively research them or find new ones for hours on end.
Distinguishing a Panic Attack from a Heart Attack
Panic attacks and heart attacks can share similar if not identical symptoms.
Anyone suffering from sudden and severe chest pain—whether being treated for anxiety disorder or not— should go to the emergency room. The physician will test the patient’s blood for specific heart muscle enzymes. If none are found, it’s usually not a heart attack.
A cardiologist sensitive to the issues of anxiety and depression will know how to sort out panic attack symptoms from heart attack symptoms, and will be able to refer the patient for treatment for panic disorder or any other type of anxiety.
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Diagnosing and Treating Anxiety
It’s important to differentiate normal anxiety from the more severe type.
Does the anxiety interfere with your family life or keep you from being productive in your professional life? Does it restrict you from engaging in the activities you like? If the answer is yes, then it’s the kind of anxiety that may require some degree of therapy or medical attention.
Depending on the duration, severity, and type of anxiety, treatment can include therapy, medication, or a combination of both. A common and effective method of treatment is cognitive behavioral therapy (CBT), which involves three main components:
- Anxiety management – The goal is to keep the patient from placing too much concentration on anxieties about the future that are impossible to control, and helpthe patient focus on the present. Anxiety management may encompass relaxation exercises, sensory focusing, and yoga techniques.
- Cognitive restructuring – People with anxiety disorders tend to “catastrophize,” or put too much weight in the possibility of disastrous or apocalyptic events.
Cognitive restructuring—through patient-therapist give and take—presents a series of logical steps that aims to prove that distorting events and situations is not a healthy thing. - Exposure therapy – Seeks to gradually and repeatedly expose the patient to the activity or environment that causes the anxiety. The successful result is reached when the individual can effectively manage the anxiety. Examples include overcoming a fear of crossing a bridge, successfully navigating a cross-country plane trip, or spending time in a location associated with an accident or crime.
Anxiety in Women
Women are about twice as likely as men to experience panic disorder, generalized anxiety disorder (PTSD), social phobia, and anxiety disorders when taken as a whole. Women are also more likely than men to get post-traumatic stress disorder, even though men are more likely to be exposed to violent and dangerous situations.
One reason may be that the types of traumas that women experience most—sexual trauma and rape—are more likely to lead to post-traumatic stress disorder.
PTSD is one of the many types of anxiety that can put stress on the heart.
The Role of Genes in Anxiety Disorder
“Just like a major heart attack, a burn is a horrible thing, says McCann. “About 33% of patients who have really severe burns develop post-traumatic stress disorder. Which makes us wonder about the 66% who do not get PTSD. We think genes are a huge part of it. We’re currently researching whether this same genetic vulnerability holds true for cardiac disease.”
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Calm your anxious heart - Harvard Health
Managing anxiety can improve your quality of life and take stress off your heart.
A wave of dread overcomes you—your chest hurts, your heart flutters, and you can't catch your breath. These classic anxiety symptoms are often mistaken for a heart attack—and for good reason. Emotional turmoil triggers the release of stress hormones, which act on the same brain areas that regulate cardiovascular functions such as heart rate and blood pressure.
A toxic mix
Anxiety most often travels in the company of its henchmen—stress and depression. In fact, anxiety and depression are likely different expressions of a shared underlying biology. As many as two-thirds of people with anxiety disorders also suffer from depression at some point in their lives, and over half of people with depression also have an anxiety disorder. Long-term, unrelenting stress can be a precursor to both conditions.
Stress, anxiety, and depression can be viewed as one family of related problems. It's hard to tease them out. For example, two people may have similar biology, but one of them is anxious, while the other is more depressed.
Heart effects
The relationship between heart health and depression is well documented. There is mounting evidence for an independent anxiety–heart disease link as well. In particular, people who have generalized anxiety disorder (see "Symptoms of generalized anxiety disorder") seem to suffer higher rates of heart attack and other cardiac events. The effect is more pronounced in people who already have a diagnosis of heart disease, and the risk rises with the intensity and frequency of anxiety symptoms.
There are several theories about how constant anxiety of this type may affect the cardiovascular system. Anxiety disorders can change the body's stress response, the combination of hormonal and physiological reactions that helps all animals fight or flee from a real threat. People with anxiety disorders have inappropriate ups and downs that can cause high blood pressure, heart rhythm disturbances, or heart attack. A malfunctioning stress response promotes inflammation, which damages the artery linings and sets the stage for the buildup of coronary plaque.
People with anxiety also have low levels of omega-3 fatty acids, and lower levels may be linked to a higher risk of heart disease. The presence of anxiety and depression also appears to make platelets "stickier," so blood is more likely to clot.
The connection between anxiety and heart health also travels in the other direction. A diagnosis of heart problems is likely to raise a person's baseline anxiety. In addition, people who are anxious may also have adopted unhealthy habits (like smoking or overeating) that add to cardiac risk.
There's still much to be learned about how anxiety affects the heart. But its harmful effects—along with stress and depression—should not be ignored.
Treating anxiety
The choice of treatment for anxiety depends on a number of factors, such as its severity, which symptoms are dominant, and other health conditions. The primary approaches for treating anxiety entail talk therapies and medications.
Very often, doctors recommend a dual approach that combines psychotherapy and medications.
Cognitive behavioral therapy, the most studied technique, helps you identify automatic negative thoughts, understand why they aren't rational, and come up with ways to limit destructive thoughts and reinforce positive ones. Depending on an individual's needs, other types of psychotherapy may be recommended. Relaxation exercises, biofeedback, and meditation are other pill-free techniques for managing anxiety.
Many people find relief by taking antidepressant medicines, including selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine (Prozac) and sertraline (Zoloft). These are especially useful in people also burdened by depression. However, when seeking medication for anxiety, be sure to discuss your cardiovascular condition with your doctor to avoid adverse effects and undesirable drug interactions.
Don't forget regular exercise, after your doctor gives you the go-ahead. It's good for your heart and also helps to boost your mood and calm your nerves.
Symptoms of generalized anxiety disorder
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Image: FatCamera/Getty Images
Heart alarm - For a healthy lifestyle! - Articles - Center of Modern Cardiology
Very often people complain of pain in the heart, but it turns out that the stomach hurts, suffers from osteochondrosis or stress has led to the development of depression.
And the development of a heart attack is not recognized, they are attributed to the same stomach, osteochondrosis or even toothache. How to figure it out? Let's try to help.
angina pectoris. That was the name in the old days of the disease that we now call angina pectoris. A heart attack usually begins with a pressing or burning pain in the center of the chest (doctors say "behind the sternum") during exercise or stress, although it can develop at rest.
The pain is quite intense, can radiate to the lower jaw, shoulders and arms (more often to the left, but possibly both), to the neck, throat and back. Sometimes it disguises itself as bursting pains in the same areas or pains in the stomach (upper abdomen - epigastrium), simulating an intestinal disorder. The pain disappears at rest in a few minutes, and if you put a nitroglycerin tablet under the tongue (or spray a spray containing nitroglycerin) - almost instantly.
If such pain lasts longer than 20-30 minutes and its intensity increases, the development of a heart attack is not excluded.
Timely assistance significantly reduces the risk of dying from a heart attack, so you need to call an ambulance team as soon as possible. Recording an ECG in a heart attack almost always helps to make a diagnosis.
Heart attack cancelled. Very often, young women come to the doctor with complaints of pain in the heart. How could it be otherwise, because through the heart we pass all our troubles, worries and joys. In this case, there is usually no cause for alarm.
In young women, "heart pain" is often functional, meaning it is not caused by angina pectoris. Female sex hormones protect blood vessels from the formation of atherosclerotic plaques. And if you look, “heart” pains bother women not in the area where “angina pectoris” likes to settle, but in the left half of the chest, in the armpit or under the left breast. They are, as a rule, in the nature of discomfort, stabbing or aching pain, and can last from half an hour to several hours or even days.
These feelings arise for various reasons. Stress, sleep deprivation, overwork, premenstrual periods…and, as a result, an anxiety or depressive disorder. The skeletal muscles are tense, on the shoulders they are compacted into painful lumps - “lumps of nerves”! Sometimes it is enough to have a short, but good rest, pleasant emotions.
In more serious cases, one has to seek help from a neurologist , a psychotherapist. Remember: the longer the depression lasts, the more difficult it is for the doctor to completely relieve you of discomfort, sleep disturbances and bad mood. However, in addition to stress, other reasons can lead to pain in the “heart area”.
"Bouquet of diseases". Osteochondrosis, a disease of sedentary people, leads to pinching of the nerve roots and the development of pain. If the thoracic spine is involved, then it is the heart that falls under the patient's suspicion - it pricks and pierces, lies on the chest with a lump or stone, catches with inhalations and sharp turns of the body, and aches for hours.
If such sensations occur during strong excitement, then the full impression of a heart attack can be formed. But the true cause of the pain in this case is the tension of the muscles of the neck and back. Unlike an attack of angina, which is quickly relieved by nitroglycerin, pain medications, massage, kneading the back with hydromassage jets can help, shock wave therapy. During examination, changes in the vertebrae can be found on an x-ray of the spine. But the ECG, even at the time of the most intense neuralgic pain, will be normal.
Chest pain may occur during a cold if it is complicated by bronchitis. Coughing can add discomfort, since already on the second day of a hacking cough, in addition to the bronchi, pectoral muscles will add to the pain. If the cold is complicated by pneumonia and pleurisy, then with a deep breath and exhalation, changes in pain can be noticed. The pain increases with inhalation, when the lungs straighten and “rub” against the inflamed pleura, and decreases with exhalation.
The doctor will recommend an X-ray of the lungs, listen with a phonendoscope for wheezing in the lungs.
Do not forget about the stomach, pancreas and gallbladder. A common cause of chest pain is intercostal neuralgia, herpes zoster, and in women - mastopathy. Regular palpations of the mammary glands must be carried out by women after 30-35 years, and if there is pain or induration, consult a doctor who will most likely refer you to an ultrasound of the mammary glands and mammography.
Gender matters, because it is in women that “heart pain” during examination turns out to be a mask of other diseases, and in men over 40 any “gastritis, osteochondrosis attack or sore tooth” may turn out to be a first-time developed heart attack. A timely visit to the doctor is necessary if the heart is at risk.
On the other hand, all the pains in the chest should not be blamed on the poor heart either.
Let's try to figure it out, analyze our feelings and try to distinguish between an attack that can threaten health and functional pain.
- Stitching or aching pain in the left side of the chest, which does not give anywhere?
- The pain begins and goes away gradually, lasts a long time, for hours, and even days, if you are stressed?
- Physical activity does not cause or increase discomfort in the heart area, and sometimes even relieves it?
- The pain does not go away after taking nitroglycerin, but subsides with sedatives?
If you answered “yes” to most of the questions, you probably don't have to worry about your heart. If so, complete the Hospital Anxiety and Depression Scale (HADS) and the CES-D questionnaire. Perhaps the stresses in your life have led to the development of depression and the consultation of a psychotherapist will relieve your "heart anxiety".
Anxiety and pain in the heart
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Radiologist
Bunak
Mark Sergeevich
Radiologist
Masri
Amir Ghazi
Radiologist
Dubrovin
Vladislav Andreevich
Radiologist
Balitskaya
Natalya Vladimirovna
Radiologist
Mammology Center
Dentistry.
