Despite our hearts' essential role in our existence, many of us go long stretches without thinking about this life-sustaining organ. After all, if it's working well, your heart doesn't exactly call attention to itself.
But being diagnosed with a heart condition can make you very aware — and concerned — about your heart's function. And even without a cardiac event or diagnosis, some people experience heightened concerns about their heart health. In some cases, this can tip over into a mental health issue known as cardiac anxiety.
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Here, learn the causes and symptoms of cardiac anxiety, along with how to cope if you're dealing with it.
What Is Cardiac Anxiety?
"Cardiac anxiety is a specific type of anxiety that is characterized by persistent and excessive worry about the health of your heart and cardiovascular system," says Annia Raja, PhD, a licensed clinical psychologist practicing in Los Angeles and across California and Texas.
It's sometimes called cardiac neurosis, which is an "anxiety reaction precipitated by a heart condition, the suspicion of having a heart condition or the fear of developing coronary disease," per the American Psychological Association (APA). Yet another term for it is cardiophobia, which is an irrational fear of developing heart disease, per the APA.
Causes and Risk Factors
Cardiac anxiety is fairly common in people who have had a cardiac incident in the past, says cardiologist Briana Costello, MD, of the Texas Heart Institute.
"Having a cardiac event, in particular a heart attack, often comes as an unwanted surprise to those it affects," Dr. Costello says. It transforms a person's life, she adds. "Along with new medications comes new fear of 'what if it happens again?'"
But sometimes cardiac anxiety can occur in people without any diagnosis of a heart condition or history of cardiac events.
"We do see our fair share of patients who — despite normal testing — continue to complain of the same cardiac symptoms and seek follow-up visits regularly to get reassurance that their heart is OK," says Wafi Momin, DO, cardiologist with UTHealth Houston Heart & Vascular and Memorial Hermann.
There are a few potential triggers of cardiac anxiety aside from being diagnosed with a heart-related condition, Raja says:
- A traumatic event
- Family history of heart disease
- High stress and anxiety levels
- A history of anxiety
- A tendency to experience somatic symptoms, or being "more likely to experience physical symptoms in response to emotional distress," Raja says (think here of someone who gets a funny tummy when they're stressed, for instance, or people who are prone to tension headaches)
Depending on your situation, some level of anxiety may be expected — that's particularly true in the weeks after a diagnosis or event, Raja says.
"However, if your anxiety persists for months or years and interferes with your daily life and functioning, it may be more problematic and warrant further attention and support," she says.
Symptoms of Cardiac Anxiety
Cardiac anxiety can take on many forms:
- Physical symptoms, and fixation on your heart's activity: People with cardiac anxiety may experience heart palpitations, chest pain and shortness of breath, Raja says. "When experiencing these sensations, it's not uncommon for someone with cardiac anxiety to become convinced that they are having a heart attack, which can further intensify their anxiety and fear," Raja says. If you have cardiac anxiety, you might become "hyperaware of any sensation in the chest," Dr. Costello says. But not everything is cause for concern. "The truth is, along with the heart, there are many other organs and tissues that can cause 'chest pain,'" Dr. Costello points out — acid reflux is a prime culprit for chest pain, for instance, as are pulled muscles and shingles, per UChicago Medicine.
- Unwanted thoughts and emotions: People with cardiac anxiety may feel a "persistent worry" about heart health, Raja says. This constant concern about your heart is mentally taxing. And it can also transform your lifestyle, leading you to "[avoid] activities that you believe may trigger heart-related symptoms," Raja says. This includes everyday — and extremely healthy — activities such as socializing and exercise, she says.
- A need for reassurance: All this worry adds up, and along with fixating on symptoms, you may find yourself in need of reassurance from anyone who can offer it — friends, family or medical experts, Raja says. "Seeking constant reassurance from doctors and asking for repeated visits despite normal testing" is a common symptom of cardiac anxiety, Dr. Momin says.
If you suspect you are having a heart attack, err on the side of getting help. No one wants an unnecessary visit to the emergency room, but chest pain is a serious symptom that warrants swift action. Go to the ER if you are experiencing severe chest pain, per the University of Maryland Medical System.
Anxiety vs. a Heart Attack
Experts agree that distinguishing between cardiophobia and a heart attack can be tricky. Cardiac anxiety can lead to physical symptoms — chest pain, racing heart and so on — that mimic cardiac disease.
"There's no real way of telling the difference without medical testing," Dr. Momin says.
- Where the pain is located: During a panic attack, it's typical for pain to stay localized in the chest, whereas a heart attack leads to radiating pain.
- How it feels: Heart attacks can make you feel pressure in your chest — this is an extreme pressure; the oft-mentioned cliche is that it feels like an elephant is sitting on your chest. A panic attack, however, may cause sharp or stabbing pains.
- What brings it on: Often a heart attack happens after physical exertion, whereas a panic attack is more likely to occur following emotional stress or out of nowhere.
- Duration: A panic attack is relatively speedy (although it certainly won't feel like it), lasting up to an hour at the high end, while a heart attack is longer-lasting, with pain vacillating in its intensity.
Dr. Momin's recommendation: Get evaluated. That way, you can "make sure there is nothing acute going on and thereafter reassurance can be provided if concern for cardiophobia becomes prevalent," he says.
How to Cope With Cardiac Anxiety
1. Get Informed
For some, ignorance can be bliss. But for others, "a lack of knowledge or understanding about heart health" can be a contributing factor that leads to cardiac anxiety developing, Raja says.
Getting more insight into heart health can be helpful, allowing you to distinguish between normal and abnormal heart-related symptoms.
"Counseling patients on what types of pain or symptoms are red flags can help them feel a sense of control and reassurance in their daily lives," Dr. Costello says.
By talking to your doctor, you can learn about the lifestyle changes that can improve your heart health.
"Talk to your doctor about any concerns or questions you have about your heart health and treatment options," Raja recommends.
Note that both Raja and Dr. Costello recommend speaking to a health care provider, and not hitting up a search engine — more on that in a moment.
2. Try Other Relaxation Methods
Consider trying a relaxation technique known as heart-focused breathing, suggests Kahina A. Louis, PsyD. Instead of breathing into your belly, try "actually creating circular breaths into and out of your heart," Louis says.
You may even want to press your hand over your heart or cup your hands together, Louis says — and as you breathe in, you can use a mantra and aim to breathe out your stressors, she says. Doing this can help you feel more in tune with your heart and also a bit more in control, Louis says.
3. Cut Back on Caffeine and Alcohol
If your days move from coffee in the a.m. to a nightcap in the evening, consider a habit shift.
"Limit your caffeine and alcohol intake, as these substances can exacerbate anxiety symptoms," Raja says. (Both make the list of the worst foods for anxiety.)
4. Get Some Exercise
There's a dual benefit to exercise, Raja notes.
First, it's good for your heart (take a look at the very best exercises for heart health). That's why the American Heart Association recommends adults get at least 150 minutes of moderate-intensity aerobic activity (like walking) or 75 minutes of vigorous aerobic activity (like running) each week.
Second, it's a powerful tool when it comes to mental wellbeing: Exercise can "boost mood and reduce anxiety levels," Raja says.
5. Seek Help
"Seeking therapy can be an effective way to address and manage cardiac anxiety," Raja says. After all, a therapist can offer support, help you develop coping skills and dig into underlying issues that are contributing to your anxiety, she says. (Here's advice on exactly how to find a therapist.)
A support group can also be helpful, allowing you to connect with people having the same experience, Raja notes.
Or rely on your trusted network: "Connect with a support system of friends, family or community members who can provide emotional support and guidance," Raja says.
It's not uncommon for individuals to respond to a medical diagnosis (particularly a serious one) with secrecy. "They really don't want to talk about it; they want to keep it very private," Louis says.
But amping down worries or keeping them private from loved ones who care about your health (physical and emotional), can impair your functioning down the line, Louis says. Instead of opting for secrecy, consider opening up and finding a safe space to express your worries, she suggests.
6. Tread Carefully Online
Between the internet and social media, you can get endless info on health matters. That's very powerful, and it empowers your decision-making around your health.
But there's a potential downside, too. "[The internet] can also be overwhelming, misleading and fear-mongering in nature," Raja says. "Seeing negative or sensationalized headlines about heart health can trigger anxiety, especially when the information is overstated, inaccurate or irrelevant to your personal situation."
All that likely goes double for what you'll encounter while scrolling on social media.
If you find that browsing online ratchets up your anxiety, avoid doing so. And think about how you're searching too, suggests Louis — rather than searching "outcomes for people with XYZ diagnosis," she says, try searching "managing XYZ diagnosis." Doing so might lead you toward content that enforces your situation is manageable, and offers up potential solutions, Louis says.
7. Focus on Facts
When you have anxiety, it can be helpful to challenge your thoughts when they become irrational or cause you to amp up your anxiety levels, Louis says. That's what is known as a maladaptive thought, and the goal is to change it into something more objective, she says.
For instance, a maladaptive thought might be circling 'round all the potential negative outcomes of a diagnosis, Louis says. A preferable option: Focus on what the doctor told you about what to expect.
This tactic is more helpful when there is a positive prognosis, or if your doctor has reassured you that you're not at a higher risk for heart-health problems.
Is Anxiety Bad for Your Heart?
There’s a connection between anxiety and heart health.
Experiencing anxiety can activate the sympathetic nervous system (aka the fight-or-flight response), Dr. Momin says. That’s “bad for people with underlying heart disease, as this can raise blood pressure and heart rate and potentially cause further cardiac complications,” he says.
A June 2010 meta-analysis in the Journal of the American College of Cardiology, which examined 20 studies involving nearly 250,000 participants, concluded anxiety was a likely risk factor for a diagnosis of coronary heart disease. (This is an older study, but it's still the largest of its kind done to date.)
The physiological effects of anxiety — as well as other mental health disorders, such as depression and PTSD — can result in calcium buildup in the arteries and heart disease, according to the Centers for Disease Control and Prevention (CDC). Anxiety can also lead to risky behaviors (think: smoking or not taking prescribed medications), which can also be harmful to the heart, per the CDC.
More remains to be teased out about the connection between anxiety and heart disease; while anxiety may be a risk factor for heart disease, that does not mean that anxiety can directly cause a heart attack.
When it comes to anxiety, “multimodality treatment is often necessary in the form of therapy, anxiety medications or certain types of blood pressure medication that often help the anxious feeling,” Dr. Costello says.
When to See a Doctor for Cardiac Anxiety
First up, if you are experiencing symptoms related to your heart, see a doctor ASAP to rule out any potential cardiac issues, Dr. Momin says. "Symptoms such as chest pain [and] shortness of breath need to be evaluated immediately by your doctor," he says.
Then there's the question of when to see someone for cardiac anxiety. "It's understandable to feel anxious after a health scare or a heart-related diagnosis, but if your anxiety persists and begins to interfere with your daily life and functioning, it may be helpful to seek support," Raja says.
Raja lists some tip-offs that indicate a professional may be helpful:
- Persistent worrying about your heart health
- Avoiding activities because you're concerned they'll trigger heart-related symptoms
- Experiencing physical symptoms, such as chest pain or palpitations
- Frequently seeking reassurance from others
- Engaging in excessive monitoring of your heart rate or other bodily sensations
As to what kind of help you seek, it could take several forms, Raja notes. "This could include talking to your primary care doctor, cardiologist and/or a mental health professional, such as a therapist or psychologist," she says.
- American Psychological Association: "cardiac neurosis"
- APA: "cardiophobia"
- UChicago Medicine: "What causes chest pain and when to consult a heart doctor"
- University of Maryland Medical System: "When to Go to the ER"
- Cleveland Clinic: "How to Tell the Difference Between a Panic Attack and a Heart Attack"
- Journal of the American College of Cardiology: "Anxiety and risk of incident coronary heart disease: a meta-analysis"
- Centers for Disease Control and Prevention: "Heart Disease and Mental Health Disorders"
- American Heart Association: "American Heart Association Recommendations for Physical Activity in Adults and Kids"
Is this an emergency? If you are experiencing serious medical symptoms, please see the National Library of Medicine’s list of signs you need emergency medical attention or call 911.