Calm your anxious heart

Published: June, 2015

Managing anxiety can improve your quality of life and take stress off your heart.

A wave of dread overcomes you—your chest hurts, your heart flutters, and you can't catch your breath. These classic anxiety symptoms are often mistaken for a heart attack—and for good reason. Emotional turmoil triggers the release of stress hormones, which act on the same brain areas that regulate cardiovascular functions such as heart rate and blood pressure.

A toxic mix

Anxiety most often travels in the company of its henchmen—stress and depression. In fact, anxiety and depression are likely different expressions of a shared underlying biology. As many as two-thirds of people with anxiety disorders also suffer from depression at some point in their lives, and over half of people with depression also have an anxiety disorder. Long-term, unrelenting stress can be a precursor to both conditions.

"Stress, anxiety, and depression can be viewed as one family of related problems. It's hard to tease them out," says Dr. Michael Miller, a psychiatrist at Harvard-affiliated Beth Israel Deaconess Medical Center. "For example, two people may have similar biology, but one of them is anxious, while the other is more depressed."

Heart effects

The relationship between heart health and depression is well documented. There is mounting evidence for an independent anxiety–heart disease link as well. In particular, people who have generalized anxiety disorder (see "Symptoms of generalized anxiety disorder") seem to suffer higher rates of heart attack and other cardiac events. The effect is more pronounced in people who already have a diagnosis of heart disease, and the risk rises with the intensity and frequency of anxiety symptoms.

There are several theories about how constant anxiety of this type may affect the cardiovascular system. Anxiety disorders can change the body's stress response, the combination of hormonal and physiological reactions that helps all animals fight or flee from a real threat. People with anxiety disorders have inappropriate ups and downs that can cause high blood pressure, heart rhythm disturbances, or heart attack. A malfunctioning stress response promotes inflammation, which damages the artery linings and sets the stage for the buildup of coronary plaque. People with anxiety also have low levels of omega-3 fatty acids, and lower levels may be linked to a higher risk of heart disease. The presence of anxiety and depression also appears to make platelets "stickier," so blood is more likely to clot.

The connection between anxiety and heart health also travels in the other direction. A diagnosis of heart problems is likely to raise a person's baseline anxiety. In addition, people who are anxious may also have adopted unhealthy habits (like smoking or overeating) that add to cardiac risk.

There's still much to be learned about how anxiety affects the heart. But its harmful effects—along with stress and depression—should not be ignored.

Treating anxiety

The choice of treatment for anxiety depends on a number of factors, such as its severity, which symptoms are dominant, and other health conditions. The primary approaches for treating anxiety entail talk therapies and medications.

Very often, doctors recommend a dual approach that combines psychotherapy and medications. Cognitive behavioral therapy, the most studied technique, helps you identify automatic negative thoughts, understand why they aren't rational, and come up with ways to limit destructive thoughts and reinforce positive ones. Depending on an individual's needs, other types of psychotherapy may be recommended. Relaxation exercises, biofeedback, and meditation are other pill-free techniques for managing anxiety.

Many people find relief by taking antidepressant medicines, including selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine (Prozac) and sertraline (Zoloft). These are especially useful in people also burdened by depression. However, when seeking medication for anxiety, be sure to discuss your cardiovascular condition with your doctor to avoid adverse effects and undesirable drug interactions, says Dr. Miller.

Don't forget regular exercise, after your doctor gives you the go-ahead. It's good for your heart and also helps to boost your mood and calm your nerves. 

Symptoms of generalized anxiety disorder

  • Persistent, excessive worry about various things for at least six months
  • Feeling tense or on edge
  • Difficulty sleeping
  • Trouble concentrating
  • Irritability or restlessness
  • Muscle tension

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