Many of us will experience symptoms of
anxiety and panic during our lives, but these symptoms can also
mimic those of heart disease.
These are natural body responses that help us on a very basic level to
escape from danger or harm. They allow the body to respond quickly and
in a heightened way. They also cause the heart rate to elevate quickly
and the force of each beat to increase.
In some people, symptoms of anxiety and panic can significantly
impair their quality of life. Severe anxiety can also stem from, as well
as cause,
depression.
General anxiety disorder is a condition in which people experience
significant symptoms of anxiety on more days than they don’t during a 6
month period. It is estimated that between 5-11 percent of people will
experience a form of general anxiety disorder during their lifetime.
As I mentioned, anxiety can be a normal reaction of the body. For
example, if you are hiking and run into a bear, the anxiety you
experience will help you get away. This is a normal response, but at
times our mind and bodies can experience anxiety from abnormal
responses.
There are a number of abnormal heart rhythms that come from the upper
heart chambers. When these rhythms are fast (over 100 beats per minute)
they are called supraventricular tachycardias or SVTs. These abnormal
rhythms can occur in completely normal hearts as well as in people that
have had
prior heart injuries or problems.
In most people they are a random event and not provoked by exercise or
other activities. They often cause symptoms of palpitations,
lightheadedness, chest discomfort, shortness of breath, and at times
passing out. The mind often has to respond to the heart beating very
fast and as such can produce symptoms of anxiety and panic.
Often in my clinic I am faced with one of two possibilities. Did
anxiety and panic make the heart go fast or did the heart going fast
make the body develop anxiety and panic?
Sometimes the answer is not easy. In the most extreme case I know, I
saw a patient that experienced a lifelong history of fear, anxiety, and
panic. She was over 70 years of age. She stopped leaving her home in
fears that she may experience a panic attack. She tried multiple
anxiety medications and therapies without benefit. When I saw her we
found that each episode of anxiety was caused by a rapid heart rhythm
that was easily corrected by a simple procedure called an ablation.
Shortly after the procedure she attended the wedding of a close relative
free of anxiety. This was the first time that she had participated in
an open family activity in nearly 40 years. Most of time what I
encounter is people who have experienced anxiety for a few years and
medications have not worked. The lack of response to anxiety medications
or additional symptoms prompted their doctors to look for additional
potential causes of the problem.
Clues to Abnormal Heart Rhythm
Here are some clues that I use to help me determine if an abnormal heart rhythm is causing the anxiety or vice versa.
1. The most straightforward clue is the pattern in which they occur.
For example, if anxiety is making the heart go fast, then usually there
is something that causes the stressful feelings followed by an elevated
heart rate. If the heart is causing the anxiety, then you will often
experience palpitations or a racing heart followed by anxiety. Sometimes
the racing heart will cause you to feel lightheaded or develop chest
discomfort and this can make the anxiety worsen or escalate.
2. Anxiety disorders or panic attacks rarely cause you to pass out.
Whenever I hear that a patient has completely passed out it raises my
concern about an abnormal heart rhythm. Many people may feel lightheaded
or dizzy if they stand up quickly or move quickly. Rarely do people
pass out during activity. If you have ever passed out during exercise or
experienced a seizure during exercise you should see a heart
specialist. It is also very uncommon to pass out unprovoked while seated
or standing. People commonly pass out when they have their blood drawn
or experience something that is unsettling, but if have no warning signs
or symptoms before you pass out the risk of a heart problem increases.
3. If you are anxious or panic you often breathe very quickly or
hyperventilate. This can cause a feeling of numbness and tingling in the
tips of your fingers on both hands and often a similar sensation around
your mouth. Most of the time these symptoms are from anxiety causing
hyperventilation. However, if you also feel lightheaded or faint they
can also represent a falling of your blood pressure and an abnormal
heart rhythm.
4. Abnormal heart rhythms often are the result of a trigger. These
triggers are extra beats from the upper and lower heart chambers. We all
experience these extra beats and they typically feel like a skipped or
hard beat. People with abnormal heart rhythms often feel these extra
beats and then suddenly the heart rhythm goes very fast, like a light
switch turning on a light. Typically with anxiety the heart rate
increases in a uniform manner without the extra or skipped beats.
5. With anxiety alone, the heart is responding in a normal manner to a
condition. With abnormal heart rhythms the heart is what is abnormal.
Abnormal rapid heart rates that persist and go untreated can result in
the heart muscle weakening. This can cause swelling or edema in the
stomach, legs, and feet. You can experience unique symptoms of trouble
breathing while lying down and the need to use extra pillows to get
comfortable at night. Anxiety-related elevated heart rates do not cause
the heart to weaken over time and these unique symptoms should not
develop.
The best way to truly understand if it is anxiety causing a fast
heart rate or a fast heart rate causing anxiety is to wear a heart
monitor. This is a simple device that records your heart rhythm day and
night for a certain number of days. I often have people wear these for
2-4 weeks. Some automatically record all heart rhythms and others
require you to push a button when you experience heart symptoms.
Unfortunately, if you don’t have any symptoms these monitors may not
provide the information needed for the diagnosis. For that reason, I
like to use them for a number of weeks to increase my chances of
capturing the event.
If you are experiencing symptoms like those discussed in this column,
contact your doctor. Your doctor will be able to treat both problems
with anxiety as well as those from abnormal heart rhythm in a variety of
ways.