Anxiety Attack or Heart Arrhythmia? How to Tell the Difference

Several months ago, a teenage girl walked into the office of Indiana University Health’s Dr. Gopi Dandamudi, a cardiac electrophysiologist. For a number of months, this softball player had complained of feeling lightheaded and dizzy on the field, as though she was going to faint.

This patient’s heart would race, but once she rested, everything returned to normal. The girl had been to several doctors, but no one could diagnose her – they all believed it was sports-related anxiety. Finally, after multiple attacks, her primary care doctor thought that her anxiety may actually be a heart arrhythmia, and he referred her to Dr. Dandamudi. It was. He operated to fix the arrhythmia, and she was cured.

“When I told her parents that she had an arrhythmia and we ablated it, they both broke down and cried,” recalls Dr. Dandamudi who serves as the medical director for the Cardiac Electrophysiology Department and program director for the Atrial Fibrillation Center at Indiana University Health. “They were nervous. Something had been happening for several months and nobody could give them an answer. In my field, we sometimes encounter patients who are diagnosed for periods of time with panic attacks, anxiety or something similar and end up having arrhythmias that are treatable and, in most cases, curable.”

So how do you know if your attacks are more than anxiety? What if they are actually a curable arrhythmia that is undiagnosed?

According to Dr. Dandamudi, there is a tremendous overlap in symptoms. A patient who presents with chest pain, inability to breathe well, queasiness and a feeling of impending doom could be diagnosed with anxiety or an arrhythmia.

The main difference between the two is your heartbeat. If your heart is racing, and you feel as though it may beat right out of your chest, then what appears to be an anxiety attack may actually be an arrhythmia. Unfortunately, unless you are having an attack while at the doctor’s office, an EKG will usually appear normal, so it is important to take your pulse during an attack and describe how your heart feels in order to help your doctor determine the cause.

Patients diagnosed with anxiety are typically treated with behavioral therapy and/or medication, and they should begin to see results within the first few months. Most people who are diagnosed with anxiety do see a decrease in symptoms with proper treatment, but if these methods of care are not working as intended, then they should explore other causes of their symptoms – it could be an arrhythmia.

“Not every patient that suffers from anxiety attacks should receive an evaluation for possible arrhythmias,” says Dr. Dandamudi. “That’s overdiagnosis and overtreatment. But if you are experiencing recurring anxiety attacks, and common treatments don’t work, then you should see if you are having cardiac rhythm problems.”

Your medical history is also an indicator as to whether or not your attacks are anxiety or an arrhythmia. If you have not previously suffered from anxiety attacks, are not participating in a strenuous activity or involved in a stressful situation when symptoms begin, then it may be an arrhythmia.

It is important to note that arrhythmias are not age specific. They can happen to people of all ages and Dr. Dandamudi says the majority of his arrhythmia patients are in their 20s through their 40s.

“Most arrhythmias are not fatal, and they are easily treatable,” explains Dr. Dandamudi. “But they do effect the quality of life.”

When determining whether or not your attack is due to anxiety or an arrhythmia, it’s important to be an empowered and knowledgeable patient. Track your symptoms carefully, express all concerns to your doctor and acknowledge when a treatment is or is not working.

-- By Gia Miller

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