By Angelica Bottaro 

 Medically reviewed by Jeffrey S. Lander, MD

An anxiety disorder is characterized by excessive worry and fear that won't go away or may get worse over time. Heart disease describes various conditions that can affect the heart and blood vessels. Anxiety disorders are common in people with heart disease and can have an impact on heart health.

In this article, we'll discuss the connection between anxiety disorder and heart disease and how one condition affects the diagnosis and treatment of the other.

Verywell / Jessica Olah

The Connection Between Anxiety Disorders and Heart Disease

Research has shown that anxiety disorders and heart disease can both cause the other to develop. If you have an anxiety disorder, including generalized anxiety disorder (GAD), panic disorder, and post-traumatic stress disorder (PTSD), you are 26% more likely to develop heart disease—especially coronary artery disease and heart failure.1

People who have anxiety for a long time experience certain changes in their bodies, including reduced blood flow to the heart, increased heart rate and blood pressure; and elevated levels of cortisol, a stress hormone released by the adrenal glands. Over time, these effects can lead to heart disease.23

Research suggests that anxiety disorders contribute to heart disease in several other ways, such as:1

• Inflammation: Both anxiety and anxiety disorders are associated with increased inflammatory markers, which indicate there is a heightened level of inflammation in the body.

• Endothelial dysfunction: The layer of cells that make up the lining of blood vessels (vascular endothelium) plays a key role in the health and maintenance of the circulatory system. Anxiety and anxiety disorders have been linked to changes in the vascular endothelium that have been implicated in inflammation, blood clots, and the buildup of fatty deposits in the arteries (atherosclerosis). 

• Platelet dysfunction: Platelets are blood cells that are responsible for blood clotting. People with anxiety and acute stress have greater platelet aggregation, which can result in abnormal blood clotting and heart attacks.

Having a heart attack can trigger the development of an anxiety disorder. Roughly 30% of people who have had a heart attack will have elevated levels of anxiety after the event.1 This anxiety might be related to the heart attack itself, the fear of death or disability, or the financial cost of medical care.

A person who is having an anxiety attack may have similar symptoms to someone experiencing a heart attack, such as:

• Shortness of breath

• Chest pain

• Dizziness

• Vertigo

• Numbness in the hands and feet

• Heart palpitations

• Fainting

• Trembling

When to See a Doctor

If you have sudden and severe chest pain, you need to seek emergency care. A doctor can test your blood for specific heart muscle enzymes to see if you are having a heart attack.

Complications of Anxiety and Heart Disease

A person with heart disease and anxiety is more likely to experience worse outcomes, such as severe disability or death, than people with heart disease who do not have anxiety.1

Anxiety can also lead to fear and uncertainty about your health. Your fears might keep you from following your treatment plan.

Though the research is mixed, people who experience anxiety appear to be less likely to engage in healthy behaviors that could help with heart disease. Anxious individuals tend to have increased dietary cholesterol intake, eat more food, live a sedentary lifestyle, and exercise less.1

Anxiety is also associated with a lower likelihood of following risk-reducing recommendations after a heart attack, including smoking cessation, social support utilization, and stress reduction.1

People with anxiety disorders are also less likely to attend and complete cardiac rehabilitation programs. These behavioral factors in people with anxiety disorders can increase the likelihood of cardiovascular morbidity and mortality.

Diagnosis of Anxiety and Heart Disease

Diagnosing anxiety disorders in people with cardiovascular disease is difficult because there is a substantial overlap between the symptoms of anxiety disorders and those of heart disease.

Accurate diagnosis is necessary for the proper treatment of these disorders. Your primary care physician can diagnose anxiety disorders and heart diseases but may refer you to a mental health professional and cardiologist for treatment.

Some tests that your doctor may perform to diagnose heart disease include:4

• Electrocardiogram (ECG or EKG): This test measures the electrical activity in your heart. There are specific patterns that your doctor looks for to determine whether there are abnormalities in your heart.

• Echocardiogram: This test is an ultrasound of the heart. A small probe (a transducer) is placed on your chest in various places to generate a picture of your heart.

• Stress test: During this test, you will be asked to wear a blood pressure monitor while walking or running on a treadmill or bicycle. You will also be hooked up to an EKG. Doctors will assess your heart rate to get a better picture of your heart health. If you cannot tolerate exercise for the test, medications can be used to cause your heart rate to increase and simulate normal reactions of the heart to exercise.

• Nuclear stress test: This test uses imaging to examine your heart before and after exercise to assess the level of physical stress exercising has on your heart.

• Positron emission tomography (PET) scan: During this test, a special dye is injected into your body and can highlight certain physical problems on imaging scans. 

Mental health conditions like anxiety disorders are diagnosed using the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5). The DSM-5 criteria for an anxiety disorder include:5

• Excessive anxiety and worry that occurs more often than not for at least six months

• Difficulty controlling levels of worry

• Feelings of anxiety that are accompanied by at least three of six total symptoms, including restlessness or feeling on edge, fatigue, difficulty concentrating, irritability, muscle tension, and sleep disturbances

• Physical and psychological symptoms cause significant issues with daily functioning

• Anxiety is not caused by drug abuse, medication, or another condition

Self-Tests for Anxiety

There are self-assessment tools that might be able to help you determine if your symptoms could be related to an anxiety disorder. For example, Mental Health America has a screening tool that tells you whether you need to see a mental health professional about your anxiety symptoms. The American Psychiatric Association (APA) provides downloadable questionnaires that you can use to get a better picture of how your anxiety symptoms are affecting your life.

Online screening tools are to be used for informational purposes only. Only your doctor or a mental health professional can diagnose you with a mental health condition.

How to Get Help in a Crisis

If you are having suicidal thoughts, dial 988 to contact the 988 Suicide & Crisis Lifeline and connect with a trained counselor. If you or a loved one are in immediate danger, call 911.

Treatment of Anxiety and Heart Disease

Having anxiety can affect the treatment of heart disease because the medications used to treat the two conditions may interact.4

Medications

The medications that you might need to treat heart disease will depend on the specific condition you have, but can include:

• Beta-blockers to manage abnormal heart rhythms

• Diuretics to help rid the body of extra fluid and sodium

• Medications to lower cholesterol levels, such as statins

Anxiety is typically treated both with medications and psychotherapy. Medications used for anxiety include:6

• Anti-anxiety medications: These medications can help reduce the symptoms of anxiety, panic attacks, or extreme fear and worry. The most common anti-anxiety medications are called benzodiazepines.

• Antidepressants: Certain types of antidepressant medications called selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are commonly used as first-line treatments for anxiety. They may help improve the way your brain uses certain chemicals that control mood or stress. 

Tricyclic Antidepressants and Heart Disease

People with heart disease should not use tricyclic antidepressants because they can cause a heart block. Research has shown that SNRIs can also be dangerous for people with heart disease. SSRIs are the first choice of medication for someone with both heart disease and an anxiety disorder.7

Psychotherapy

Cognitive-behavioral therapy (CBT) is the most common type of therapy that is used for anxiety. It teaches people different ways of thinking, behaving, and reacting to anxiety-producing and fearful objects and situations.

Two types of CBT are commonly used to treat anxiety disorders:

• Exposure therapy focuses on confronting the fears underlying an anxiety disorder to help people engage in activities that they have been avoiding.

• Cognitive therapy focuses on identifying, challenging, and then neutralizing unhelpful or distorted thoughts underlying anxiety disorders.8

Coping With Anxiety and Heart Disease

If you have heart disease and an anxiety disorder, there are several steps that you can take to learn how to manage both conditions effectively.

Lifestyle Changes

Dietary changes can be beneficial for anxiety and heart disease because diet influences the development and progression of both conditions.910

Eating whole foods that are rich in many nutrients and vitamins and limiting foods that can cause inflammation, such as deep-fried foods, high-fat foods, and processed foods, is beneficial for both heart disease and anxiety.

Managing your stress levels through relaxation techniques like deep breathing can help alleviate stress. Exercising regularly can also help reduce stress. Research has shown that people who exercise more regularly have better-managed anxiety levels.11 For heart disease, exercise can also help manage blood pressure, reduce cholesterol, and strengthen the heart muscle.12  

While lifestyle interventions can help you manage heart disease and anxiety, it's still important that you discuss your treatment with your doctor and/or a mental health professional.

Support Groups

Being able to connect with people who understand what you’re going through validates your feelings and can help you feel less alone.

The National Alliance on Mental Illness (NAMI) offers different support groups for people with anxiety. The American Heart Association (AHA) offers a support network for people with heart disease to connect with one another.

Summary

Heart disease and anxiety are closely connected. People who have an anxiety disorder are at higher risk of developing heart disease than people who do not have anxiety. On the flip side, people with heart disease are more likely to develop an anxiety disorder after a heart attack.

Getting a proper diagnosis for anxiety and heart disease will help you get the treatment and support that you need to effectively manage both conditions.

12 Sources

Celano CM, Daunis DJ, Lokko HN, et al. Anxiety disorders and cardiovascular disease. Curr Psychiatry Rep. 2016;18(11):101. doi:10.1007/s11920-016-0739-5

Olafiranye O, Jean-Louis G, Zizi F, Nunes J, Vincent M. Anxiety and cardiovascular risk: Review of epidemiological and clinical evidence. Mind Brain. 2011;2(1):32-37.

Johns Hopkins Medicine. Anxiety and heart disease.

Brewer LC, Svatikova A, Mulvagh SL. The challenges of prevention, diagnosis, and treatment of ischemic heart disease in women. Cardiovasc Drugs Ther. 2015;29(4):355-368. doi:10.1007/s10557-015-6607-4

National Center for Biotechnology Information. Impact of the DMS-IV to DSM-5 changes on the national survey on drug use and health.

Bandelow B, Michaelis S, Wedekind D. Treatment of anxiety disorders. Dialogues Clin Neurosci. 2017;19(2):93-107. doi:10.31887/DCNS.2017.19.2/bbandelow.

Yekehtaz H, Farokhnia M, Akhondzadeh S. Cardiovascular considerations in antidepressant therapy: an evidence-based review. J Tehran Heart Cent. 2013;8(4):169-176.

National Institute of Mental Health. Anxiety disorders.

Casas R, Castro-Barquero S, Estruch R, et al. Nutrition and cardiovascular health. Int J Mol Sci. 2018;19(12):3988. doi:10.3390/ijms19123988

Masana MF, Tyrovolas S, Kolia N, et al. Dietary Patterns and Their Association with Anxiety Symptoms among Older Adults: The ATTICA Study. Nutrients. 2019 May 31;11(6):1250. doi:10.3390/nu11061250

Shepardson RL, Tapio J, Funderburk JS. Self-Management Strategies for Stress and Anxiety Used by Nontreatment Seeking Veteran Primary Care Patients. Mil Med. 2017 Jul;182(7):e1747-e1754. doi:10.7205/MILMED-D-16-00378

U.S. National Library of Medicine. Being active when you have heart disease.

By Angelica Bottaro
Angelica Bottaro is a professional freelance writer with over 5 years of experience. She has been educated in both psychology and journalism, and her dual education has given her the research and writing skills needed to deliver sound and engaging content in the health space.