Do I Have Heart Problems or Anxiety? Here’s What You Need to Know

Anxiety and heart problems can both be frightening, debilitating and may impact your quality of life. Thanks to certain symptoms, it can be difficult to know whether you are dealing with anxiety or underlying heart problems.

Research has shown that of all the patients who visit emergency services with low-risk chest pain, 30-40%¹ are actually experiencing moderate to severe anxiety.

Anxiety occurs due to psychological causes, while heart problems are caused by physical conditions. However, it can be very difficult to differentiate them without proper examination, because many of the symptoms overlap. 

For example, symptoms associated with both anxiety and heart problems can include:

• A pounding or racing heart 

• Abnormal heartbeats or palpitations (when it feels like your heart flutters or skips a beat)

• Chest pain 

• Shortness of breath 

• Dizziness 

• A sense of dread or doom 

• Sweating 

• A tingling or numb feeling in the limbs.

To make it more complicated, it is possible to have both anxiety and physical heart problems, or experience one that then leads to the other. 

Studies have shown that long-term anxiety disorders are associated with² the onset and progression of heart disease, likely because anxiety and anxiety disorders are associated with inflammation. In fact, people with an anxiety disorder have a 26% greater chance of developing coronary heart disease, and a 48% increased risk of heart-related death.³ 

On the other hand, physical heart problems can contribute to anxiety. Approximately 70-80%⁴ of people who have suffered from a heart attack have greater levels of anxiety afterward — which can then put them at risk for developing further heart problems. 

Read on to learn how to determine if your heart-related symptoms are likely due to anxiety, or if they could stem from a physical heart problem.

What is anxiety and why does it occur?

Anxiety is the body’s natural response to a life-threatening situation. When the body detects a threat, it triggers a stress response known as fight or flight, which is designed to help you survive the stressor. 

Chemical messengers called adrenaline and cortisol are released at this time and cause an increase in heart rate and more forceful beating. This sends more blood to organs essential for survival, like the brain and lungs. Once the perceived threat has gone, these symptoms will subside.

Those with an anxiety disorder such as generalized anxiety, panic disorder, and social anxiety, struggle to turn this stress response off — even in everyday life when there is no apparent trigger. This means they more frequently experience heart-related symptoms, which can lead to a prolonged heart rate and increased blood pressure.

This response can also bring on an anxiety attack or a panic attack. Both have similar effects on the heart and display similar symptoms. Panic attacks generally come on suddenly whilst anxiety attacks follow a period of extended worry. 

Although they can feel very similar to a heart attack, they are not life-threatening. However, having a heart attack misdiagnosed as anxiety could be life-threatening. 

How do physical heart problems arise?

Heart problems encompass a wide range of conditions. Issues can arise due to physical problems in the vessels or pumping chambers of the heart, which makes it difficult to pump and/or send oxygen around the body. This can lead to chest pain and issues such as:

• Angina (when blood flow to the heart is reduced and a part of the heart cannot get oxygen)

• Heart attack (when blood flow to the heart is blocked)

• Coronary artery disease

• Heart failure (when the heart cannot pump effectively) 

• Arrhythmias such as atrial fibrillation (an irregular heartbeat).

How can you tell the difference between anxiety and heart problems?

Although this is not a definitive list or diagnostic criteria, knowing the differences between anxiety and heart problems can be helpful if you are experiencing chest pain and other heart-related symptoms. 

The type of pain

The type of pain felt during a heart attack is quite different from the pain that you may feel when you have a panic attack.

Common types of pain associated with heart attacks include:

• Pain that spreads to areas like the arms, shoulder blades, and jaw.

• A pressure-like pain, aching and squeezing.

• A burning sensation in your chest.

• Swelling in the feet, legs, and stomach due to arrhythmia. 

If you suffer a panic attack, you might feel:

• Sharp stabbing pain in the chest.

The trigger and onset of rapid heart rate

In anxiety, the sudden increase in heart rate⁵ occurs directly after or during an emotionally stressful situation that the body deems to be a threat. In most cases, this occurs without any skipped beats. 

However, the sudden increase in heart rate for people with heart conditions, such as angina or during a heart attack, usually occurs due to physical exertion. Sometimes, it can occur at rest or for no reason at all and it is common for the heart to skip a beat. 

Duration of heart-related symptoms?

An anxiety attack generally lasts between 5 and 20 minutes.⁶ They can occur multiple times in a day and across consecutive days and the symptoms can come in waves. 

Heart attacks, however, can last from a few minutes to a few hours. Without medical attention, the chest pain can increase in severity throughout the attack. 

Prior medical history 

If you are younger than 40 years old, have no history of cardiovascular disease, low blood pressure, and are healthy (a non-smoker, consume a low saturated fat diet, and are a healthy weight), you are much more likely to be experiencing anxiety rather than physiological heart problems. 

What can you do about it?

If you develop sudden and severe chest pain,⁷ pressure in the chest for more than ten minutes, and/or chest pain that travels to your arm or jaw, you should call emergency services or get someone to take you to the emergency room immediately. 

It is always better to be safe than sorry — so even if you don’t have these three critical symptoms but are unable to determine the cause of the pain, you should still seek medical attention. Although anxiety is distressing and needs to be taken seriously, it is not life-threatening in the same way that many heart conditions can be. 

Once you know the cause of your symptoms, your doctor can put together a treatment plan. 

Treatment for heart problems can include:

• Medication

• Lifestyle changes, such as diet and exercise

• Repairing the damage to the heart through surgery. 

On the other hand, treatment for anxiety aims to ease psychological symptoms and  generally includes:

• Psychotherapy

• Medication

• Lifestyle changes.

Seeing a doctor 

The best to determine whether you are suffering from anxiety or heart problems is to see a doctor. They can examine you, request tests and scans, and assess your psychological state. 

The tests could include: 

• A chest x-ray, to see the size of the heart and blood vessels 

• An ECG, which measure the electrical functioning of the heart

• An echocardiogram, which uses ultrasound to create an image of the structure of the heart. This is often performed on a treadmill to see the impact of physical exertion on your heart rate, heart rhythm, and electrical activity. 

• A blood test for troponin. Troponin is a protein found in the heart muscle. When there is heart damage following a heart attack, troponin is released into the blood. 

• A cardiac catheterization, which involves a tube being inserted into a chamber or vessel of the heart to see whether a part of the heart is getting enough blood flow. 

The results from these tests will allow your doctor to determine whether you have physical heart problems, or if they may be anxiety-related.

The lowdown 

Experiencing any kind of heart issue can be worrying. Therefore, it’s important to determine whether your symptoms are based on psychological factors such as anxiety, or if they are due to a physical heart problem. This will ensure that you can start effective treatments and get the best support possible for your condition.