Anxiety can Disguise Heart Disease Symptoms in Women

• Anxiety disorders are more commonly observed in women than in men.
• Women suffering from an anxiety disorder may have less blood pumping to their hearts while exercising.
• Heart disease symptoms in women may be atypical, unlike in men.
• Heart disease detection in women must be based on objective tests as symptoms of anxiety may mask the symptoms of an underlying heart disease, making the diagnosis difficult to ascertain.

Heart disease is the number one cause of death in women worldwide. The symptoms of anxiety and mood disorders, like palpitations (sensation of having a rapid heartbeat), flushing and discomfort in the chest, may conceal the symptoms of heart disease in women and thus delay diagnosis and treatment. A study recently conducted at University of Quebec, Canada supports the theory.

Overview of the Study

The study was conducted by Kim Lavoie, a professor of Psychology at the University of Quebec at Montreal and her team. 2300 subjects were included in the study, out of which 760 were women. SPECT (Single Photon Emission Computed Tomography) exercise stress test was conducted and followed by a psychiatric interview (The Primary Care Evaluation of Mental Disorders). The aim of the study was to examine the effects of gender and mood disorders on the risk of myocardial ischemia (reduction of blood supply to the heart). The study and its results were published in the journal- Circulation: Cardiovascular Quality and Outcomes.

Risk Factors for Heart Disease in Women

The study has revealed that anxiety may not just have emotional manifestations. It may have physical ramifications in women as well.

• Psychiatric diseases and mood disorders like panic disorders and/or anxiety, may increase the risk of ischemia in women. Anxiety in itself, can cause spasms of the coronary arteries and reduce perfusion of the heart without the presence of a coronary artery blockage. It can also cause chronic stress, which may lead to constantly elevated levels of cortisol in the body, which can be a risk factor for the development of heart disease.  Stress also leads to behavioral changes, e.g. smoking, which are not conducive to good cardiac health.
• Men experience the classic symptoms of chest pain and shortness of breath in coronary artery blockage while women experience atypical ones like palpitations, hot flushes, chest discomfort and neck pain. These are very similar to the signs of anxiety and the diagnosis of a coronary artery disease may be missed or delayed. Stress is also associated with an abnormal autonomic control. This may be the reason why women with coronary artery disease show worse outcomes than their male counterparts.
• Another study conducted by Deepak L.Bhatt, MD, MPH, FACC, across 366 U.S. hospitals and over 49000 patients revealed that women were less likely to receive appropriate care as compared to men and therefore, showed a higher mortality rate owing to sub-optimal care. This revelation, coupled with the theory that heart disease is often misdiagnosed in women as anxiety, can have serious consequences.

The study has sent across an important message- stress and anxiety may deteriorate the health of a woman’s heart.

• Anxiety and psychiatric disorders must be taken seriously and treated early with cognitive therapies and medication.
• Physicians need to test women extensively before attributing the cause to a psychogenic source instead of coronary artery blockage.
• Women with anxiety disorders must be tested for heart disease as anxiety predisposes such patients to myocardial ischemia.
• Awareness among women must be raised over stress management and the adoption of a healthy and active lifestyle to ensure good cardiac health.

 Experts Opinion

‘The idea that stress can be related to ischemia and even a heart attack is an important message to get across,’’ said Dr. Carolyn Lam Su Ping, senior consultant at the National Heart Centre in Singapore.

Physicians over the world have been researching long over the association of stress and anxiety with heart disease. This study has proven once again that the concern possibly holds true. Anxiety has a detrimental effect on pre-existing heart conditions and even delays diagnosis and treatment.

Physicians have divided opinions on this issue, but quite a few believe that there may exist a diagnostic bias due to the similarity of symptoms of anxiety and heart disease that may cause labeling of women with coronary artery disease as those suffering from a mood disorder. This study supports the fact that physicians need to assess patients both physically as well as mentally as anxiety is a common ailment of the modern world. Not treating anxiety may have equally disastrous effects as misdiagnosing an underlying heart condition as anxiety.

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Further research needs to be undertaken in order to ascertain the extent to which anxiety and mood disorders affect the outcomes in patients with coronary artery disease and whether early intervention and treatment of psychiatric ailments can result in improved outcomes in these patients.

References:

1. https://www.nlm.nih.gov/medlineplus/news/fullstory_157417.html
2. http://newsroom.heart.org/news/special-issue-highlights-new-heart-disease-research-on-women-call-for-more
3. http://www.acc.org/latest-in-cardiology/articles/2016/02/23/16/45/study-finds-women-may-be-less-likely-to-receive-optimal-care?w_nav=Tab
4. Laura D. Kubzansky, Ichiro Kawachi, Scott T. Weiss, David Sparrow; ‘’Anxiety and Coronary Heart Disease: A synthesis of epidemiological, psychological, and experimental evidence’’, Annals of Behavioural Medicine, June 1998, Volume 20, Issue 2

Source-Medindia