Worried (Heart) Sick? How Anxiety Triggers Heart Ills

Study finds anxiety is linked to serious heart problems.

ByKIM CAROLLO, ABC News Medical Unit
July 5, 2010, 4:53 PM

July 6, 2010 -- Deanna Pierott ended up in the hospital twice last year after she experienced tightness in her chest, shortness of breath and a light sweat.

In both cases, she originally suspected a heart attack, but fortunately this was not the case.

Her diagnosis? Anxiety.

"I even had an angiogram, but they didn't find anything wrong with my heart. They said it was anxiety," Pierott said. "My doctors told me to slow down, and advised me to do things to try and calm down," she added.

Despite both her cardiac scares, Pierott said her doctors have not found any evidence of coronary heart disease -- at least not yet.

But a group of researchers found a very strong association between generalized anxiety disorder, or GAD, and the occurrence of cardiovascular events such as strokes, heart attacks, heart failure and death.

The researchers looked at patients who experienced chest pain and other symptoms when they exerted themselves and engaged in certain other activities -- a condition known as stable coronary heart disease.

They found that people who had this type of heart disease, plus GAD, had a higher rate of cardiovascular events than did patients who did not suffer from GAD. The findings also showed that risk factors for heart disease such as smoking, physical inactivity and skipping meds did not play a role in the greater number of cardiovascular events.

In short, these findings suggest, GAD can predict whether people with stable coronary heart disease will have a stroke, heart attack or other serious heart problem. While an association between anxiety disorders and heart disease has long been suspected, doctors say this study is unique.

"It looks at something as specific as generalized anxiety disorder, which is a very specific and new correlation," said Dr. Sudeepta Varma, clinical assistant professor of psychiatry at NYU Langone Medical Center.

Dr. Una McCann, associate professor of psychiatry at The Johns Hopkins University School of Medicine, believes a study like this one is long overdue.

"Many patients with depression and anxiety are only diagnosed with depression, even when anxiety is the more prominent symptom," she said. "Anxiety is often viewed as less important. As a result, it is underdiagnosed (or misdiagnosed) and understudied."

Link May Be Due to Effects of Chronic Stress

The study did not pinpoint the factors involved in the link between the two medical conditions, but medical experts have their theories.

"I suspect that many of these subjects have panic attacks or surges in anxiety," said McCann. "This would likely be associated with intermittent surges in blood pressure, which would be detrimental to individuals with pre-existing cardiovascular disease and might also contribute to the development of CVD."

"Generalized anxiety disorder is correlated with high levels of chronic stress and chronic worry, and we know that chronic stress, because of the cortisol being elevated for long periods of time, can lead to an increased risk for heart disease," said Varma.

Chronic stress seems to be the very definition of 51-year-old Pierott's life.

She owns two businesses, is involved in politics in her home city of Vancouver, Wash., is a single mother to a teenage son, and cares for a mother with dementia.

"I never seem to do better in terms of removing things from my plate," she said. "Even if I remove something, I'll add something else in its place."

Even when she started experiencing cardiac symptoms back in November, she didn't want to leave her business lunch to go the hospital.

"I thought, 'I don't want to create a scene,' and I went ahead and finished my lunch because I thought it might be indigestion," she said.

That's very common in people with GAD.

"The hallmark of GAD is the perception of threats that others might perceive as neutral events," said Varma. "They will always have things to worry about."

"There are conflicting beliefs. They'll believe that anxiety makes them suffer, but on the other hand, anxiety gets the job done," Varma added.

Heart Problems Lead to Even More Anxiety

Sharon Chayra of Las Vegas is very familiar with fear. Like Pierott, she is a busy business owner and mother. On top of that, she's going through a divorce and is also getting over a broken relationship.

She's been suffering from anxiety for the past two decades, and she's also suffered serious cardiac symptoms.

"At times, I wake up with tachycardia [the sensation that the heart is pounding] or I'll feel flush," she said.

She had a panic attack about 20 years ago and was hospitalized for it. Her doctors found she had mitral valve prolapse, which medical experts say is believed to be associated with panic attacks.

During her panic attack, she had a spasm in her larynx that made it difficult to breathe.

Because of that spasm and her recurrent bouts of heart palpitations and tachycardia, she is always in fear that the worst possible consequence awaits her.

"I definitely worry about having a heart attack," she said. "And the fear of something happening makes my anxiety worse."

"If you knew that you had just had a heart attack or were told that you had cardiovascular disease, this can lead to anxiety, panic attacks, episodes of intermittent high blood pressure, et cetera," said McCann.

"This could help explain the relationship between anxiety and CHD (coronary heart disease)."

Study Sends Important Message to Doctors

Dr. Philip Ragno, director of cardiovascular health and wellness at Winthop University Hospital, said he and many other cardiologists are very aware that extreme stress has been associated with an increased risk for cardiovascular problems, especially in people with existing heart disease.

A study like this one, he said, drives that point home even more.

"This is more of an important study for physicians to be aware of so that when doctors see patients in their office, they make special note of their anxiety and other symptoms," he said. "It shows us that many conditions are multifaceted and it's extremely important for doctors to work together so people's risk factors can be controlled."

But others say this study sends a much more important message.

"It's a call to action to people with GAD that they need to get help. Not only are you feeling miserable physically and mentally, but you can die from it," said Varma.

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