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The Medical Minute: Heart, mind – a profound connection

It’s a vicious cycle and a common one.

When dealing with a health issue, specifically something serious such as a heart condition, physical well-being isn’t the only thing in jeopardy.

It’s natural to worry about the future, but too much worry can cause a mental strain. Anxiety or depression can set in, and lack of personal motivation as well as medication to treat those conditions can have a negative effect on energy levels. Those patients could become more sedentary and less apt to do what’s needed to improve heart health.

So, the connection between mental and heart health goes both ways. Heart problems can make you worry, and worry can ultimately lead to heart problems.

“It is actually quite substantial,” said Dr. Safwat Gassis, Penn State Heart and Vascular Institute’s director of cardiac electrophysiology and its atrial fibrillation clinic. “There is a very strong association in both directions. Many different types of mental health conditions can either mimic or exacerbate heart problems and vice versa. People with heart conditions can profoundly exacerbate mental conditions, whether that is anxiety or depression or paranoia.”

Confusing symptoms

One of the keys to maintaining a healthy heart and mind is possessing a strong knowledge base of symptoms, conditions and medical histories. To build that database, Gassis said, it is important to engage in dialogue with medical professionals to best understand what is happening to you and why and what the treatment should be, including what side effects certain medicines may trigger.

The tricky part is that symptoms of certain heart issues – such as palpitations or arrhythmia – can be similar to mental health issues like anxiety or panic attacks. Therefore, patients may confuse one for another, potentially making a situation worse. For instance, a benign heart-rhythm issue such as extra or premature heartbeats can be mistaken for something more serious, which can ramp up one’s anxiety and cause adrenaline (the fight or flight hormone) release in the blood, which then can speed the heartbeat and continue the circle.

“When a person has a heart arrhythmia, a heart rate can be rapid or irregular. That’s caused by let’s say a short circuit in the heart itself. But what they feel is this pounding, shortness of breath, dizziness and light-headedness and tingling, which are identical symptoms to a panic attack,” Gassis said. “I’ve seen this many, many times where a heart condition is confused for panic attacks or anxiety and vice versa, where a person may think they have a heart rhythm issue where it’s actually symptoms of anxiety.”

When to seek help

The first thing you should do, Gassis said, is determine the severity of the symptoms. If your heartbeat is accelerating and you own a blood pressure cuff or have another way to monitor heart rate or other vitals, do so as soon as possible. That will provide context.

More severe symptoms, such as acute chest pain or major difficulty breathing, should be viewed as an emergency and help should be sought immediately.

“If somebody is feeling like they are gasping for air, are really short of breath and are having chest pains, and those symptoms are severe, then it is best to get it checked out right away,” he said. “So, the severity of the symptoms dictates that. Not all palpitations, feeling a little fluttering, requires somebody to drop what they are doing and go get checked out right away.”

If you experience heart fluttering or other palpitations without pain while lying down at night, for instance, stay calm and make note of what is happening and if there are any patterns. Then take that information to a physician to determine the root issue – and whether it’s heart- or mental-health related or both.

Proper evaluation, Gassis said, is important because it can lead to peace of mind. Oftentimes, patients who are dealing with irregular heartbeats – and the subsequent anxiety that is associated with them – will be prescribed monitors to wear for days or weeks so that patterns can be determined. Once the results are studied, doctors form a better understanding of what is happening and how best to treat the symptoms.

Having that knowledge and a treatment plan in place can go a long way to easing concerns. That’s why Gassis said, it can be “extremely beneficial” to address mental health and heart health issues simultaneously.

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The Medical Minute is a weekly health news feature produced by Penn State Health. Articles feature the expertise of faculty, physicians and staff, and are designed to offer timely, relevant health information of interest to a broad audience.

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