Is it Anxiety or Heart Disease? Sometimes It's Hard To Tell The Difference

Many of us will experience anxiety or panic attacks during our lives, both of which have symptoms that can mimic heart diseases like atrial fibrillation — an irregular heart beat. How do you know if symptoms are anxiety or heart disease?

Anxiety and panic symptoms are natural responses to help your body escape from danger or harm. They quickly elevate your heart rate and increase the force of each beat, similar to symptoms of atrial fibrillation. If you're hiking and run into a bear, the anxiety you experience will help you get away. This is a normal response. But at times, your mind and body can experience anxiety from abnormal responses.

Symptoms of anxiety and panic attacks can significantly impair quality of life. Severe anxiety can stem from, as well as cause, depression. Five to 11 percent of people experience general anxiety disorder during their lifetime, which is defined as significant anxiety symptoms on more days than not during a six month period.

A Patient's Anxiety or Heart Disease?

One patient I saw, who was over age 70, had a lifelong history of anxiety and panic attacks. She'd stopped leaving her home out of fear of another attack after she'd tried multiple anxiety medications without benefit. But when I saw her, we found that each episode of her anxiety was caused by a rapid heart rhythm. It was easily corrected by a simple procedure called an ablation.

Shortly after the ablation, she attended a close relative's wedding free of anxiety. This was the first time she'd participated in a large family activity in nearly 40 years.

Tachycardia Can Cause Anxiety

Abnormal heart rhythms of more than 100 beats per minute that come from the upper heart chambers are called supraventricular tachycardias (SVTs). These can occur in healthy hearts as well as in people who've had prior heart injuries or problems. In most people, SVTs are random events not triggered by exercise or other activities. SVTs cause symptoms of heart palpitations, lightheadedness, chest discomfort, shortness of breath, and, at times, they may cause you to pass out. The mind responds and can cause further symptoms of anxiety and panic.

Most of the time, I encounter people who've had anxiety for a few years — and for whom medications haven't worked — which prompted their doctors to look for additional potential causes.

5 Clues That Indicate Abnormal Heart Rhythms

In my clinic, I'm often faced with two possibilities:

  • Did anxiety cause the rapid heart rate?
  • Did the rapid heart rate cause anxiety?

Here are some clues:

1. Symptom pattern This is the most straightforward clue. If anxiety makes your heart race, then something causes stressful feelings that are followed by an elevated heart rate. But if your heart is causing the anxiety, then heart palpitations or a racing heart comes first, followed by anxiety. Sometimes the racing heart causes lightheadedness or chest discomfort, and anxiety escalates.

2. Passing out or seizure This raises my concern about an abnormal heart rhythm. Anxiety disorders or panic attacks rarely cause you to pass out. You might pass out when having blood drawn or experiencing something unsettling. But if you have no warning signs before passing out, the risk of a heart problem increases. Many people feel lightheaded or dizzy if they stand up quickly; but people rarely pass out while seated, standing, or during an activity. If you've ever passed out while exercising or experienced a seizure, you should see a heart specialist.

3. Hyperventilating When you're anxious or panicking, you may hyperventilate. This can cause numbness and tingling in the tips of your fingers on both hands, and around your mouth. Usually, anxiety causes this hyperventilation. But if you also feel lightheaded or faint, your blood pressure may be falling, indicating an abnormal heart rhythm.

4. Triggers Abnormal heart rhythms often result from a trigger: extra heart beats in the upper and lower heart chambers. We all experience extra beats at times; they feel like a skipped or hard heart beat. But people with abnormal heart rhythms often feel these extra beats, and suddenly their heart races as if a light switch turned on a light. In contrast, with anxiety, the heart rate increases uniformly without extra or skipped beats.

5. Weakening heart With anxiety, the heart responds in a normal way. But with abnormal heart rhythms like atrial fibrillation, it's the heart that's abnormal — and if left untreated, it can weaken the heart and lead to heart failure. This can cause swelling (edema) in the stomach, legs, and feet. You may experience trouble breathing while lying down and need to use extra pillows to get comfortable at night. Anxiety-related elevated heart rates do not cause the heart to weaken over time or cause edema.

Monitor Your Heart to Detect Anxiety or Atrial Fibrillation

The best way to truly understand whether anxiety causes a fast heart rate, or if a fast heart rate causes anxiety, is to monitor your heart.

A heart monitor records your heart rhythm day and night. Some automatically record all heart rhythms; others require you to push a button when you feel heart symptoms. When you don’t have symptoms, heart monitors may not provide the information needed for a diagnosis. For that reason, I have patients use them for two to four weeks to increase my chances of capturing the event.

Over the past two years, more people are using their smartphones to keep track of their activity and heart rate, but each device has limitations. What's important, however, is your daily trend.

Your heart rate varies throughout the day by a few beats per minute (bpm) up to 10 bpm, even when doing very little activity or experiencing infrequent stress. When exercising, the variation may be more pronounced and change more quickly, which allows us to quickly adapt to different situations and challenges. When you look at the daily trend, you will quickly find your normal. This normal will have the lowest heart rates at night, and then change predictably during the day while at work and rest, and during exercise.

How to Detect Abnormal Heart Rhythm Patterns

Abnormal heart rhythms have three patterns, and the first is the easiest to figure out: You develop a sudden elevated heart rate with anxiety. Your device will show an abrupt heart rate acceleration, and when symptoms stop, the device should abruptly return to normal. This is usually shown as a spike in the graph of more than 30 to 40 bpm.

The second really depends on understanding your normal heart rate. In this pattern, the heart rate is exaggerated during rest or by an activity. If your heart rate while sleeping at night is typically 40 to 60 bpm, for example, but on a seemingly normal night it jumps to 70 to 90 bpm, you may have a form of an SVT called atrial tachycardia. In atrial tachycardia, the changing heart rate pattern is abnormal for you, it can last for longer periods of time, and it may occur without symptoms. The heart rate in atrial tachycardia is often more than 20 to 30 bpm faster than your normal heart rate would be for that same activity.

The last pattern is one in which the heart rate can vary dramatically from beat to beat; this is seen in people with a very abnormal heart rate, such as atrial fibrillation. In some people, the heart rate is mildly elevated, while in others it may be more than 100 bpm. The smartphone graphs a chaotic, abnormal pattern with broad swings in the tracing from beat to beat. This same pattern can be seen in people with very frequent extra beats from the upper and lower heart chambers.

If you're using your smartphone to understand your heart, first get a sense of what's normal for you over a number of days or weeks when you don’t have symptoms. When you develop symptoms, compare those smartphone graphs with the ones that you collected during a period when you felt normal. These reports will help you and your physician understand your heart and determine if your heart rhythm is behind your symptoms of anxiety, or if anxiety causes your heart to race.

If you are experiencing symptoms like those discussed in this column, contact your doctor, who will be able to treat problems related to anxiety as well as those caused by an abnormal heart rhythm in a variety of ways.

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