ANXIETY, ANGER & HEART DISEASE : Is it a causal relationship?

Anxiety and anger is a very commonly seen feature in our population. People of the valley irrespective of their religious and social affiliations have been seen to be especially prone to these disorders.

Links between the heart and emotion have been postulated for centuries. However, data supporting this connection have only become available recently. A growing body of evidence now suggests that negative affective states, including anxiety, lead to an increased risk for cardiovascular disease, and that the presence of negative affective states are associated with poor long-term prognosis.

Although much of the literature exploring the relationship between cardiovascular disease and emotion has been focused on depression, Treating physicians often encounter the presence of anxiety in patients with confirmed or suspected heart disease. In addition to being one of the most common psychiatric illnesses the anxiety disorders as a group are over-represented in patients with heart ailments. High blood pressure is one of the commonest associations. Several studies have found that anxiety is associated with increased cardiac mortality in patients with heart disease. This fact however is contested by some researchers.

Anxiety Disorders mimicking heart disease

Panic Disorder

The symptoms of a panic attack often mimic those of a heart attack, and can include chest pain, shortness of breath, stomach discomfort, dizziness, and a sense of impending death. Indeed, until properly diagnosed, many patients believe that they are having heart attacks when they panic, leading to repeated emergency room visits and expensive diagnostic procedures. While panic attacks themselves are not deadly, there is accumulating evidence that patients with panic disorder are more prone to get serious problems like sudden death if they actually get a heart attack. It is therefore important to recognize panic disorder in the absence of heart disease both for heart health and psychological well-being. The mechanism of the panic attack is often hyperventilation, a surge of adrenaline release or hypersensitivity.

It feels like as if your heart is getting squeezed. You can’t get a deep breath. You get chest pains. You feel weak. You genuinely feel as though you’re about to die. After some time it just goes away

What happened? Many people worry they suffered from a heart attack. But what you may have suffered from is a panic attack. Don’t let the name fool you – panic attacks cause very real physical symptoms that mimic those of a heart attack, yet in general, nothing is wrong with your heart.

The treatment of panic disorder without a known cause in persons without heart disease is cognitive- behavioral therapy and specific drug therapy using a group of medicines called serotonin reuptake inhibitors. These individuals should also be advised regarding the importance of minimizing the use of caffeine and stimulant drugs, and of maintaining good sleep hygiene.

Normal Anxiety and Heart Disease

Following a major heart event, such as a myocardial infarction (heart attack) or after angioplasty or bypass surgery anxiety is the norm. Patients are suddenly confronted with their own mortality and are understandably concerned about the potential future impact of their diagnosis and illness on their occupations, personal lives, and relationships with others. It is important for the treating physician to anticipate this “normal illness-related anxiety” and address it promptly to prevent avoidable complications.

Serious cardiac events are traumatic and life-threatening. Some patients develop intrusive thoughts, memories, or nightmares about their cardiac event; avoidance of situations that remind them of the event; and increased arousal (eg, irritability, insomnia). When these symptoms have been present for <1 month (but develop within 4 weeks of the traumatic event), they are considered as acute stress disorders but if they persist for >1 month, they are classified as post traumatic stress disorders by psychiatrists. These require specific medications under supervision. Self medications by drugs like alpralozam and sleeping tablets etc should be avoided. These can interfere with the specific medications often prescribed by the treating physician.

Points to Remember

1. There is growing evidence that anxiety is an independent risk factor for the development of heart disease.
2. Anxiety following a heart attack or related illness can slow down the recovery process and can be associated with higher morbidity and mortality.
3. Treating such disorders is important. The management consists of psychoeducation, behavioral therapy, and in many cases medications from the group of serotonin reuptake inhibitors taken under medical supervision.

(Dr. Upendra Kaul*founder director of GHHP, Kashmiri Cardiologist, Recipient of Dr B C Roy Award and Padma Shri. Past president of Cardiological Society of India, SAARC Cardiac Society, Member Board of Trustee, SCAI.  Currently Course Director of AICT /ASIAPCR and INDALIVE.)