Anger, Hostility, Anxiety

Anxiety, anger, and hostility are commonly seen features in our population, with senior citizens being particularly prone to them. Links between the heart and emotions have been theorized for centuries, but data supporting this connection have only recently become available. A growing body of evidence suggests that negative emotional states, including anxiety, increase the risk of cardiovascular disease and are associated with a poor long-term prognosis.

While much of the literature exploring the relationship between cardiovascular disease and emotions has focused on depression, treating physicians often encounter anxiety in patients with confirmed or suspected heart disease. Anxiety disorders as a group are overrepresented in patients with heart ailments, with high blood pressure being one of the most common associations. Several studies have found that anxiety is associated with increased cardiac mortality in patients with heart disease, although this fact is contested by some researchers.

Anxiety Disorders mimicking heart disease

Panic Disorder

The symptoms of a panic attack often mimic those of a heart attack, and can include chest pain, shortness of breath, stomach discomfort, dizziness, and a sense of impending death. Indeed, until properly diagnosed, many patients believe that they are having heart attacks when they panic, leading to repeated emergency room visits and expensive diagnostic procedures. While panic attacks themselves are not deadly, there is accumulating evidence that patients with panic disorder are more prone to get serious problems like sudden death if they actually get a heart attackIt is therefore important to recognise panic disorder in the absence of heart disease both for heart health and psychological well-being. The mechanism of the panic attack is often hyperventilation, a surge of adrenaline release or hypersensitivity.

It feels as if your heart is getting squeezed. You can’t get a deep breath. You get chest pains. You feel weak. You genuinely feel as though you’re about to die. After some time, it just goes away.

The treatment of panic disorder without a known cause in persons without heart disease is cognitive- behavioural therapy and specific drug therapy using a group of medicines called serotonin reuptake inhibitors. These individuals should also be advised regarding the importance of minimising the use of caffeine and stimulant drugs, and of maintaining good sleep hygiene.

Hostility and Heart disease

Hostility is a personality trait that includes being sarcastic, cynical, resentful, impatient or irritable. It’s not just a one-off occurrence but characterises how a person interacts with people. This trait is often seen in patients who have had a heart attack, is often seen in smokers, inactive persons with poor health behaviours. It has been established that taking control of lifestyle habits improves the outlook and good counselling is very effective.

Simple Anxiety and Heart Disease

Following a major heart event, such as a myocardial infarction (heart attack) or after angioplasty or bypass surgery anxiety is the norm. Patients are suddenly confronted with their own life in danger and are understandably concerned about the potential future impact on their lives. It is important for the treating physician to anticipate this “normal illness-related anxiety” and address it promptly to prevent avoidable complications.

Serious cardiac events are traumatic and life-threatening. Some patients develop intrusive thoughts, memories, or nightmares about their cardiac event; avoidance of situations that remind them of the event; and increased irritability, and lack of sleep. When these symptoms have been present for <1 month (but develop within 4 weeks of the traumatic event), they are considered as acute stress disorders but if they persist for >1 month, they are classified as post-traumatic stress disorders by psychiatrists. These require specific medications under supervision. Self-medications by drugs like alprazolam and sleeping tablets etc. should be avoided. These can interfere with the specific medications often prescribed by the treating physician.

Points to Remember

1. There is growing evidence that anxiety is an independent risk factor for the development of heart disease.

2. Anxiety following a heart attack or related illness can slow down the recovery process and can be associated with higher morbidity and mortality.

3. The trait of being hostile is often seen after getting a major illness like a heart attack. Unless managed well it can lead to another episode.

4. Treating such disorders is important. The management consists of psycho education, behavioral therapy and in many cases medications from the group of serotonin reuptake inhibitors taken under medical supervision.

5. Lastly, it is the responsibility of adult children to take care of the mental and physical health of their parents and ensure their happiness. They should avoid causing any stress or anxiety through their words or actions.

Disclaimer: The views and opinions expressed in this article are the personal opinions of the author.

The facts, analysis, assumptions and perspective appearing in the article do not reflect the views of GK