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How Anxiety Can Mimic Angina

Faiq Shaikh, M.D.
How Anxiety Can Mimic Angina

Angina is everyone's worst fear. It is one of the first signs of severe heart disease, and everyone knows that if they feel any type of pain or discomfort around your heart, you need to contact the doctor immediately.

What people don't realize is that anxiety can cause nearly identical types of heart discomfort or pain, and unfortunately this type of chest pain often results in an anxiety attack that also mimics the effects of a heart attack.

Panic Attacks or Angina

Anxiety - specifically panic attacks can mimic heart disease so strongly that many people are hospitalized after their first panic attack because they're worried that they may be dying. The symptoms can be so similar that until modern testing and understanding they have actually been confused for each other.

Anxiety causes many symptoms that are directly associated with angina, and the two share a host of symptoms that are often described as nearly identical:

These are all exactly the same symptoms that cause so much distress to those with panic attacks, and while the two are not literally identical, they share so many issues in common that it's no wonder people that experience them worry that they have angina.

Hyperventilation is the Cause of Angina-like Symptoms

What causes angina-like symptoms when you have anxiety? The answer is a breathing problem known as hyperventilation.

Hyperventilation is the act of breathing out too much carbon dioxide before your body has time to make more, either because you're breathing too quickly or you're breathing in too much and breathing it all out fast. While people think that carbon dioxide is bad for your body, it's actually a necessary for several different functions. When carbon dioxide levels are low, your blood vessels constrict, which leads to less oxygen to the brain, slower blood flow, etc.

This, in turn, causes the chest to experience more pressure and pain. It cause your heartbeat to speed up to compensate for the slower blood movement. It causes lightheadedness that make people think something is wrong with their heart because it reduces blood flow to the brain. All of these are caused by hyperventilation.

Perhaps the most interesting effect is that hyperventilation creates a feeling of not having enough oxygen. The result is that people feel as though they can't breathe, so they try to breathe in more or faster in order to compensate, only to make their hyperventilation worse.

Adding to this is that hyperventilation is often associated with panic attacks, and the anxiety from panic attacks also creates a "feeling of doom" as a symptom, which makes those that are suffering from hyperventilation feel that the symptoms indicate that they are about to die. That is why angina and panic disorder not only feel similar in symptoms, but also in terms of emotions.

How to Tell the Difference Between Angina and Anxiety Chest Pain

Angina is indicative of a heart attack but also can be similar to the experience of having a panic attack.

The best way to rule it out is to talk to your doctor. If your heart is in good health and everything checks out, it's extremely rare to have any heart condition. While panic attacks can occur at any age, they're more common at ages when coronary disease is rare, between the ages of 20 and 40. Chances are if you do not have a history of heart problems, you do not have angina. But always check with your doctor at least once and let them know of your concerns and what you’re expereincing.

The chest pains themselves tend to be different, and although this is by no means definitive, the following are some of the ways you may be able to tell the difference:

Unfortunately that's about it. Angina attacks really do feel similar to hyperventilation. Although angina doesn't mean that a person is having a heart attack, so if you're constantly following up your "angina attacks" with a panic attack, it may be more of a sign that you actually have anxiety. Angina attacks mean you are more at risk for a heart attack, but you are unlikely to have heart attack symptoms.

The best thing you can do is talk to your doctor. Make sure your heart is in good health, then start to work on controlling your anxiety so that you don't concern yourself with your chest pains anymore and prevent your anxiety from causing further hyperventilation.

Article Resources
  1. Sanderson, William C., Ronald M. Rapee, and David H. Barlow. The influence of an illusion of control on panic attacks induced via inhalation of 5.5% carbon dioxide-enriched air. Archives of General Psychiatry 46.2 (1989): 157.
  2. Wulsin, Lawson R., et al. Screening emergency room patients with atypical chest pain for depression and panic disorder. The International Journal of Psychiatry in Medicine 18.4 (1988): 315-323.
  3. Beitman, Bernard D., et al. Non-fearful panic disorder: Panic attacks without fear. Behaviour research and therapy 25.6 (1987): 487-492.
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