Can anxiety cause abnormal EKG?

In this article, we find out whether can anxiety cause abnormal EKG. We explain what an electrocardiogram is, the factors influencing the EKG results, and when an EKG is recommended. 

Anxiety and panic – Can anxiety cause abnormal EKG?

“… They told me it was anxiety … but what if I wasn’t diagnosed correctly?” … “Okay, not this time, but if it happens again I will surely have a heart attack” … “This is not normal, I am concerned that I am overloading my body and ending up with heart disease.“

These issues are often raised by people with panic disorder. These patients usually go to the emergency department suffering from chest pain or discomfort, tachycardia and feeling of shortness of breath. There they are explored in more or less depth to finally be informed that theirs has been “just anxiety”. 

It is estimated that around 20% of people admitted to the emergency room for chest pain are having a panic attack. The most frequent intervention consists of the administration of a tranquiliser and the recommendation to reduce the level of stress.

But who has gone through the experience of feeling that he has been on the verge of death is not usually content with that explanation? The intensity of the symptoms has been such that the person doubts that the diagnosis has been correct and feels that he has narrowly escaped a fatal consequence.

If the state of anxiety persists and the person experiences new panic attacks, they may be referred to the psychiatrist or psychologist, who initially explains the physiology of the anxiety and the similarity to heart attacks. However, although the patient learns to recognize that his symptoms are caused by anxiety, he usually persists in the fear that his cardiovascular system is deteriorating due to the repetition of panic attacks.

Recently Caldirola et al. (2016) conducted a systematic review of research on the connection between panic disorder (PD) and cardiovascular disorders (CD). In general, it is suggested that susceptibility to panic may play a role in the development of arteriosclerotic heart disease (acute pathology that includes stable and unstable angina and myocardial infarction). 

Attempts have also been made to link the occurrence of arrhythmias with panic, but only in one study has an association been found between benign palpitations and PD.

The preceding statements do not mean that panic is a cardiovascular risk factor by itself. The nature of the association between anxiety and heart disease is not clearly established. 

On the one hand, there are direct (physiological) mechanisms that PD and CD share. 

Unbalanced autonomic regulation (low parasympathetic activity), insufficient reduction in blood pressure and instability of heart rate during sleep, increased arterial stiffness, and an irregular breathing pattern with basal hyperventilation has been observed in panic patients.

No evidence has been found of a specific alteration of the electrocardiogram (QT interval) that predisposes to arrhythmia or sudden cardiac death, nor are there any documented cases of the latter in relation to anxiety.

The fact that both anxiety disorders and cardiac disorders share physiological mechanisms does not imply that the former is the cause of the latter. So it cannot be said that a history of panic episodes weakens the body and leads to cardiovascular disorders. 

Perhaps it could mean that people who have a vulnerability to panic also have it for cardiovascular problems so that the latter can appear in the absence of the former and vice versa. It also seems logical to think that those who have a diagnosed cardiovascular pathology are more vulnerable to suffering panic attacks since small symptoms can be interpreted as a heart attack so that the level of anxiety shoots up quickly.

Lastly, to point out the enormous importance of indirect (behavioural) mechanisms that favour the appearance of CD in people with PD. Virtually all people who suffer from anxiety disorders end up developing behaviours that, although initially reduce their anxiety, in the long term not only increase it but also favour the appearance of other social or health problems. 

They are the so-called counterproductive or boomerang behaviours. In panic disorder, the person suffers from mistaking the bodily symptoms of anxiety for medical conditions that compromise their survival. 

The symptoms produce a general acceleration of the organism (increased heart and respiratory rate, motor restlessness, muscular tension, etc.), the reason why the person will tend to reduce her rhythm. 

This normally involves avoiding physical activity (sometimes drastically), consuming nervous system depressants (alcohol), and unhealthy behaviours like smoking or eating unbalanced. This type of behaviour constitutes a well-established risk factor for the development of cardiovascular pathology.

Electrocardiogram – EKG: what is it?

In some cases, your doctor may suggest that you have an electrocardiogram, also called an EKG, to check for signs of a possible cardiovascular disease. The electrocardiogram or EKG is a test that records the electrical activity of your heart, through small electrodes that a technician attaches to your skin, chest area, arms and legs.

EKG is a fast, safe and painless analysis. With this test, your doctor will be able to:

• to check your heartbeat (rhythm);

 • see if you have poor blood circulation to the heart muscle (this is called ischemia);

• to diagnose a myocardial infarction, as it is also called a heart attack;

• check for aspects that are abnormal, such as thickened heart muscle (myocardium).

An electrocardiogram (EKG) is a test that looks for problems with your heart’s electrical activity. An EKG shows the electrical activity of your heart like lines left on paper. Sudden increases and decreases in these lines are called where.

Factors influencing the EKG result

Certain factors or conditions can influence or affect the results of an exercise EKG, for example, a procedure that is done to assess the heart’s response to exercise or exercise. These factors include (but are not limited to) the following:

• if the patient ate a large meal, drank a lot of caffeine and/or smoked before the procedure;

• hypertension;

• electrolyte imbalances, such as too much or too little potassium in the blood, too much or too little magnesium and/or too much or too little calcium in the blood; 

• use of certain medications;

• heart valve disease;

• enlarged left ventricle.

At the same time, there are other factors or conditions that can affect/influence the results of an electrocardiogram, and among them are:

• obesity,

• pregnancy,

• accumulation of fluid in the abdomen (ascites),

• anatomical considerations, such as chest size and location of the heart in the chest,

• if the patient moves during the test.

When is an EKG recommended

An electrocardiogram is a simple and painless test that measures the electrical activity of your heart. It is also known as an EKG or ECG. Each heartbeat is triggered by an electrical signal that starts at the top of your heart and travels (is transmitted) to the bottom of your heart.

Heart problems often affect the electrical activity of the heart, and your doctor may recommend that you have an EKG if you experience symptoms or signs that may suggest that you have a heart problem, such as:

• chest pain,

• respiratory problems,

• you feel tired or weak,

• you have the feeling that your heart is beating hard, that it is beating too fast or that it is beating abnormally,

• you have the feeling that your heart is beating after an “uneven” pattern,

• Detecting unusual sounds when your doctor listens to your heart with a stethoscope.

An EKG will help your doctor determine what is causing your symptoms, but also what type of treatment may be needed in your case.

If you are 50 years of age or older or have a family history of cardiovascular disease, your doctor may also recommend an EKG to see if there are any early signs of heart disease.

The electrocardiogram has proven to be one of the most useful diagnostic tests in clinical medicine. It is commonly used in the evaluation of patients for the detection of myocardial (heart muscle) lesions, cardiac ischemia and the presence of a previous infarction.

At the same time, it is used in the evaluation of patients with electrolyte disorders, patients with certain drug toxicities, as well as patients with implantable defibrillators and pacemakers.

FAQ on Can anxiety cause abnormal EKG

What is Cardiac Anxiety?

Cardiac Anxiety, also known as Da Costa’s syndrome, makes the patient believe that he/she is suffering from heart disease, or even a heart attack, even though the patient doesn’t actually have any cardiac issues. 

Conclusions

In this article, we tried to find out whether can anxiety cause abnormal EKG. We explained what an electrocardiogram is, the factors influencing the EKG results, and when an EKG is recommended. 

In conclusion, it has not been established that there is a specific risk for cardiovascular health in anxious patients. A different problem is how anxiety affects patients with cardiovascular conditions or risks. The relationship found between both disorders requires a greater number of studies and a methodological improvement that allows controlling for possible confounding variables.

References

Caldirola, D., Schruers, K. R., Nardi, A. E., De Berardis, D., Fornaro, M., & Perna, G. (2016). Is there a cardiac risk in panic disorder? An updated systematic review. Journal of Affective Disorders, 194, 38–49.

John Hopkins Medicine – What is an electrocardiogram?

American College of Cardiology – Electrocardiogram, Test Overview

Blood Pressure UK – Electrocardiogram (ECG) and high blood pressure

MedicineNet – Electrocardiogram (ECG or EKG)