Health Article: Is It Anxiety or Heart Disease? Sometimes It’s Hard to Tell the Difference By T. Jared Bunch, MD

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.