It can often be difficult to determine if symptoms like chest pain, shortness of breath, and palpitations are due to heart failure or anxiety. Both conditions can cause similar symptoms and often co-occur. This article will examine how to differentiate between heart failure and anxiety when experiencing concerning symptoms.
What is heart failure?
Heart failure is a condition where the heart cannot pump enough blood and oxygen to meet the body’s needs. It usually develops gradually over time as the heart’s pumping function grows weaker. Common causes include coronary artery disease, high blood pressure, heart defects, and heart infections.
In heart failure, the weakened heart cannot fill up with blood properly or pump blood efficiently around the body. As a result, fluid can back up into the lungs (causing shortness of breath) or build up in the feet, ankles and legs (causing swelling). The congested and underperfused tissues trigger symptoms like fatigue and weakness.
Symptoms of heart failure:
- Shortness of breath especially with exertion or lying down
- Fatigue and weakness
- Swelling of feet, ankles, legs
- Rapid or irregular heartbeat
- Reduced ability to exercise
- Chest pain
- Cough or wheezing with white or pink mucus
- Lack of appetite, nausea
- Difficulty concentrating
- Increased need to urinate at night
What is anxiety?
Anxiety is a normal emotion that everyone experiences at times, often in response to stress. However, for some people anxiety becomes excessive, persistent, and out of proportion to the situation. This can develop into an anxiety disorder.
People with anxiety disorders have recurring intrusive thoughts or concerns that trigger feelings of apprehension, fear, uneasiness, or dread. Anxiety activates the body’s fight-or-flight response, causing physical symptoms like a pounding heart, sweating, trembling, dizziness, and shortness of breath.
Symptoms of anxiety:
- Feeling nervous, restless or tense
- Having a sense of impending danger, panic, or doom
- Increased heart rate
- Breathing rapidly (hyperventilation)
- Sweating
- Trembling
- Feeling weak or tired
- Trouble concentrating
- Irritability
- Sleep problems
- Gastrointestinal issues
How to tell the difference
As you can see, some symptoms of heart failure and anxiety overlap, like palpitations, shortness of breath, and trouble concentrating. However, there are some key differences to help tell them apart:
| Heart Failure Symptoms | Anxiety Symptoms |
|---|---|
| Occur when lying down or with exertion | Not necessarily triggered, can occur “out of the blue” |
| Cause primarily physical symptoms | Cause both physical and mental symptoms |
| Get worse over time if untreated | Come and go in intensity |
| Swelling in legs/ankles/feet | No swelling |
| Coughing up pink, frothy mucus | No cough or mucus |
| Irregular, racing heartbeat | Rapid but regular heartbeat |
Additionally, heart failure symptoms tend to get gradually worse over time if left untreated, while anxiety symptoms may fluctuate in severity and come and go. With heart failure, you often wake up at night needing to urinate due to fluid buildup. Anxiety does not cause nighttime urination.
When to see a doctor
If you experience any persistent chest pain, pressure, tightness, or discomfort, it’s important to get medical care promptly to rule out a heart condition. Other “red flag” symptoms that warrant immediate medical attention include:
- Fainting or dizziness
- Racing, irregular heartbeat that does not settle down
- Severe shortness of breath
- Coughing up pink, frothy mucus
- Swelling in both legs
For milder symptoms, it’s still a good idea to make an appointment with your healthcare provider for evaluation. They can check your heart function and rhythm with tests like an EKG, echocardiogram, bloodwork, or stress test. Let them know if you have a family history of heart problems or risk factors like high blood pressure, high cholesterol, or diabetes.
Your doctor can also assess for anxiety by asking about your symptoms, thoughts, sleep patterns, and mental health history. They may recommend screening assessments for depression and anxiety.
Treatment
If heart failure is diagnosed, treatment focuses on improving heart function with medications like ACE inhibitors, beta blockers, and diuretics. Lifestyle changes like restricting salt, exercising, and losing weight are also important.
For anxiety, your doctor may prescribe anti-anxiety medications or therapy to help manage symptoms. Learning stress management skills in cognitive behavioral therapy (CBT) can help reduce anxiety.
Making healthy lifestyle choices is also beneficial – regular exercise, enough sleep, cutting back on alcohol and caffeine, eating a balanced diet, and finding positive outlets for stress. Practicing relaxation techniques like deep breathing, yoga, and mindfulness meditation can also calm anxiety.
When anxiety mimics heart disease
In some cases, anxiety causes physical symptoms so severe that heart disease is initially suspected. Some examples of this include:
Anxiety-related chest pain
Sharp chest pains from anxiety can mimic the chest tightness associated with angina, a heart condition. In anxiety, this pain is caused by tense chest muscles rather than blocked heart arteries.
Mitral valve prolapse
Some people with MVP, a minor heart valve issue, have anxiety about their health that actually brings on MVP symptoms like palpitations and chest pain.
Stress cardiomyopathy
Also known as “broken heart syndrome”, severe emotional stress can temporarily cause heart muscle weakness resembling a heart attack.
Panic attacks
Intense bouts of anxiety with a racing heart, dizziness, tremors, and shortness of breath may be mistaken for heart events.
In these situations, extensive cardiac testing shows the heart is structurally normal. Treating the underlying anxiety helps resolve physical symptoms.
When heart issues lead to anxiety
On the flip side, living with chronic heart failure or other heart problems understandably provokes anxiety in many patients. Having a life-threatening illness causes significant distress. Struggling daily with symptoms like shortness of breath also understandably leads to anxiety and fear.
Managing anxiety in these patients through counseling, medication, relaxation techniques, prayer/spirituality, or support groups can improve their overall wellbeing and quality of life.
Takeaways
- Heart failure and anxiety disorder can both cause symptoms like shortness of breath, palpitations, and fatigue.
- Heart failure symptoms get worse with exertion and over time without treatment.
- Anxiety symptoms fluctuate in intensity and are associated with mental symptoms like dread.
- Have any chest pain or “red flag” symptoms evaluated promptly to rule out heart conditions.
- See your doctor to help determine if symptoms are caused by heart failure, anxiety, or both.
- Treat any diagnosed heart failure with lifestyle changes and medications.
- Treat anxiety with therapy, medication, lifestyle changes, and self-care techniques.
Pay attention to your symptoms and how they respond to activity and rest. Keep track of what makes them better or worse. Staying mindful of your body’s signals and discussing them with your doctor can help differentiate whether heart failure, anxiety, or a combination is affecting your health.