Anxiety

Anxiety can mean nervousness and worry, many cardiac patients feel anxious during treatment. Some develop anxiety disorders. Patients who have cardiac issues may require some help to deal with whatever level of anxiety they experience as a result of their medical issues.

People with certain anxiety disorders are also at higher risk for cardiac issues. Anxiety has physical effects on the body, including the heart.

There are several types of anxiety disorders, including:

General Anxiety Disorder (GAD) is chronic worrying, people that have GAD will worry most days for at least six months. General Anxiety Disorder means that a person worries about routine parts of life, which can cause issues in their everyday life and social interactions.

Social Anxiety Disorder: people with social anxiety have intense fear of social or performance situations. People with social anxiety disorder sometimes avoid social situations in order to avoid experiencing social anxiety. They may worry about how others view them, specifically if they view the behaviors associated with their anxiety negatively.

Panic Disorder (PD) causes people to have panic attacks. A panic attack is sudden, intense fear that comes on suddenly. A panic attack can be triggered, or it can occur unexpectedly. People with panic disorder experience panic attacks chronically.

Phobia-related disorders: a phobia is an intense, irrational fear of certain objects or situations. The fear that a person will feel with a phobia doesn't correspond to the reality of the situation, or its risk level. Examples of phobias include agoraphobia, claustrophobia, and arachnophobia.

Post-Traumatic Stress Disorder (PTSD) affects people who have experienced trauma in some cases. Examples of trauma include war, natural disasters, physical or sexual abuse, or a serious accident. PTSD can cause flashbacks, sleep issues, and outbursts, among other symptoms. People with PTSD are at higher risk for cardiac issues, as well as pain, diabetes, digestive, respiratory, reproductive and digestive issues.

Anxiety disorders can be intertwined as both a risk factor and a symptom of heart disease. The difference between these two is that, as a risk factor, anxiety causes the issues in the heart. As a symptom, feelings of anxiety or an anxiety disorder can develop because of cardiac issues. The information below will go over both aspects of how anxiety is linked to heart disease.

Anxiety as a Risk Factor

The physical symptoms of anxiety can have an effect on the heart:

  • Anxiety can cause tachycardia (fast heart rate) which increases the risk of cardiac arrest.
  • Anxiety can also cause an increase in blood pressure which, if chronic, can lead to heart failure, coronary disease, and weakening of the heart muscle.
  • Decreased heart rate variability due to anxiety can result in a higher incidence of death following an acute heart attack.

Anxiety disorders, in studies, were shown to be linked to cardiovascular issues. Anxiety is a risk factor for coronary heart disease, stroke, cardiovascular mortality and heart failure. Specifically, phobia anxiety disorders are linked to a higher risk coronary heart disease, and PTSD is associated with a higher risk of stroke. People with PTSD are also more likely to have high blood pressure, hyperlipidemia, obesity, and cardiovascular disease.

Certain anxiety disorders, like general anxiety disorder, panic disorder, and post-traumatic stress disorder, are linked to cardiac health. Because of the chemicals involved in the "fight or flight" response that generalized anxiety disorder causes, including the stress hormone cortisol, heart attacks and other cardiac events become more likely.

Anxiety as a Symptom

Anxiety is often experienced as a symptom of heart disease. Patients that have had acute cardiac events (called acute coronary syndrome) are likely to become anxious. These patients experience higher anxiety levels at a rate of about 20-30%, and about 13% meet criteria for an anxiety disorder.

About 13-15% of heart attack survivors experience PTSD as a symptom. For many, heart attacks are a traumatic event, so they experience hypervigilant worrying about another heart attack, and avoid reminders of their trauma. PTSD is more common in younger heart attack victims, and studies show that heart attack survivors with PTSD are at twice the risk of a second heart attack.

Anxiety can also affect heart attack recovery. The fear and worry that comes with an anxiety disorder, like general anxiety disorder, panic disorder, or phobias, can keep a person being treated for heart disease or heart attack from following the treatment plan properly. The parts of the treatment plan that anxiety can interfere with include: resuming professional and family responsibilities, keeping a healthy diet, taking medications, and prescribed exercise regimens. Anxiety can also cause issues with sleep, patients that are being treated for heart disease, or after a heart attack, should avoid sleep disturbances as a part of treatment.

Prevention

The symptoms of anxiety can be controlled, improving quality of life. There isn't a way to prevent feelings of anxiety, or to prevent the possibility of an anxiety disorder developing. Lifestyle changes, including stopping or limiting caffeine, regular exercise, a healthy diet, and seeking counseling after disturbing or traumatic experiences can be helpful in reducing anxiety and its symptoms.

Smoking cessation, or not beginning to smoke cigarettes, can also be helpful. Heavy cigarette smoking is associated with anxiety disorders such as panic disorders and agoraphobia in adolescents, as well as ADHD and major depressive disorder. There is an interaction between the onset of mental health conditions and smoking. Smoking cessation can be helpful as part of dealing with anxiety and anxiety disorders.

Treatment

Talk therapy and certain medications can help manage anxiety. Patients may use medication, therapy, or combine the two as part of their treatment. If you are concerned about your anxiety levels, your physician can provide a referral to a therapist. You can also find therapists through your insurance company, or online.

Holistic: Cognitive behavioral therapy (CBT) is a common form of talk therapy, it has three main parts: cognitive restructuring, anxiety management, and exposure therapy. Cognitive restructuring works to unwind the tendency of people with anxiety disorders to "catastrophize", which is to put too much worry into the possibility of catastrophes or disasters. Anxiety management sometimes includes sensory focusing, yoga, and relaxation exercises. Exposure therapy is used to help a person with an anxiety disorder learn to healthily experience situations that they would otherwise avoid to keep from having to worry, this form of therapy is usually gradual and repetitive. Exposure therapy is successful when the patient is able to manage their anxiety.

Clinical: Medications for anxiety disorders include antidepressants, anti-anxiety drugs (eg. benzodiazepines), and beta-blockers.