According to data from the National Institute of Mental Health, 31.1 percent of Americans will have an anxiety condition at some point in their lives. According to the Anxiety and Depression Association of America, these diseases may sometimes produce symptoms that resemble cardiovascular problems, such as shortness of breath, chest discomfort, or an apparent increase in heart rate. Additionally, some anxiety disorder symptoms can cause abnormal ECG test readings. Preexisting or test-induced anxiety may play a role in false positives for rhythm abnormalities or other issues.
How can healthcare professionals distinguish changes brought on by underlying or transient worry from those caused by heart issues? Even though the evidence is conflicting, several case studies highlight the need to be more vigilant with ECG readings and, where feasible, examine patient history for pertinent risk factors.
Being careful with ECG interpretation may be more crucial than ever, given that many Americans are coping with financial and other pressures connected to the epidemic while combating a public health danger known to inflict permanent cardiac damage.
Abnormal ECG Results brought on by Anxiety
Anxiety may be linked to specific ECG abnormalities, such as T-wave inversion, due to acute test anxiety or a persistent illness. In one study from the American Journal of Cardiology, authors noted that anxiety and depression affected T-wave inversion in opposite ways. For example, fear made a person less likely to experience an inversion, while depression made them more likely to experience inversions in the T-wave. Inversions are frequently discussed in studies analyzing patients diagnosed with mental health conditions. The authors of the Archives of Medical Science urge frequent supervision of patients using tricyclic antidepressants, selective serotonin reuptake inhibitors (SSRIs), and other medications since certain high-dose or regular-dose anxiety drugs may cause QT prolongation.
Short-term anxiety may also interfere with ECG readings in persons without a documented clinical history of anxiety or other mental health issues. The patient, a 28-year-old man in apparently good condition, allegedly feared getting shocked by the leads. One minute after the operator gave the patient the go-ahead to keep quiet, a subsequent ECG revealed entirely expected results.
Physicians must be aware of these possible anomalies, but it’s also essential to know which ECG alterations are more likely to be brought on by chronic or recent worry. There isn’t much proof that either anxiety or depression may cause anomalies in T-wave amplitude or QT-interval adjusted for heart rate, as the authors of a paper in Frontiers in Neuroscience underlined.
Diagnosis
To determine if your anxiety may be linked to your physical health, you may start by scheduling an appointment with your primary care physician. They may look for indications of an underlying illness that could need treatment.
A psychologist and certain other mental health specialists may identify anxiety and provide treatment (psychotherapy).
Anxiety and concern about things that are commonplace or usual, as well as persistent and excessive anxiety, are symptoms of generalized anxiety disorder. The concern is extreme compared to the situation, hard to regulate, and impacts how you physically feel. It often co-occurs with depression or other anxiety disorders.
The Rise of Smart ECG Devices
Patients have increasingly begun to choose wearable ECGs, such as those available in smart watches and mobile applications. Since these ECGs have been used to identify, track, and lessen the symptoms of anxiety disorders, they may be utilized to treat individuals experiencing anxiety. However, literature analysis of studies employing these devices published in Brain Sciences found conflicting and unreliable evidence in favor of their usage.
Patients who utilize wearable ECGs may get conflicting information about whether waveform alterations occurred. These devices could be helpful, but they might not be therapeutically applicable until more is understood about how they can be used to treat anxiety and cardiac response.
Risk Reduction for Variable Readings
A physical examination, a 12-lead ECG, and a review of medical history, including mental health history, should be performed. Close monitoring is necessary if anxiety or depression has a history, especially (but not only) for patients taking medication.
Additionally, healthcare professionals should be aware of the potential emotional effects of ECG testing on patients at the point of treatment, mainly when COVID-19-related stress is already high. For some people, leads may be frightening and—as with the Egyptian patient—could give rise to worries about electric shock or other phobias. To counteract any transitory cardiac measures that can affect diagnosis, doctors should try to be comforting. If short-term stresses are thought to cause any irregularities, the ECG and EKG test should be retaken.
Most significantly, the symptoms and the ECG test reading may not all result from worry. Diligence matters—especially today when cases of missed STEMI and other diseases are misdiagnosed as a simple concern (especially among women who are most prone to anxiety).
