Anxiety, Heart Palpitations, and AFib: When to Worry

Life can be stressful at times, so many people will experience some degree of anxiety at one time or another, whether at work or home.

Anxiety and an arrythmia called atrial fibrillation, also known as AFib, can have some similar symptoms, but it is important to see a doctor to distinguish between the two. AFib can lead to serious health issues like stroke and heart failure if left untreated, according to Dr. Marshal Fox, cardiologist and electrophysiologist at Baystate Health and assistant professor of Medicine at UMass Chan Medical School – Baystate.

AFib causes an irregular heart rate that can make your heart feel as if it is fluttering or skipping beats. Panic attacks, on the other hand, can be brought on by anxiety and cause a rapid heart rate with no irregularities. Panic attacks typically come on quickly and last no more than a half hour or so, while AFib episodes can last longer, sometimes hours or days.

While panic attacks, which can cause symptoms like a choking sensation, nausea, and feeling out of control, are an emotional experience of fear or dread, AFib is a physical issue that can cause symptoms like chest pain, confusion, dizziness or lightheadedness, fainting, fatigue, intolerance to exercise, and shortness of breath.

What Causes Heart Palpitations?

“Both atrial fibrillation and anxiety can lead to similar symptoms of palpitations, shortness of breath, chest pain, dizziness and fatigue,” says Dr. Fox. “Although both share similar symptoms, the reasons for the symptoms differ significantly. Anxiety is triggered by excess activation of the body’s stress system leading to a surge in adrenaline, whereas AFib is due to abnormal electrical activation of the heart. With anxiety, the heart rate may increase but it is almost always regular. AFib, however, is characteristically an irregular rhythm.”

What is AFib?

AFib, a common arrhythmia, is an abnormal heart rhythm. The heart regulates each beat with electrical signals, but when someone has AFib, those signals fire erratically causing the heart’s two upper chambers to beat out of sync, quivering instead of beating.

“The heartbeat is normally set by the intrinsic pacemaker we are all born with called the sinus node,” says Dr. Fox. “Occasionally, an irregular heart rhythm (arrhythmia) takes over the normal sinus rhythm and can lead to various symptoms and complications.  The most common arrhythmia in the United States is AFib, which affects 1 percent of all people and nearly 10 percent of people older than 80 years old. AFib occurs when electrical signals in the top part of the heart (atria) become chaotic, which cause the heart to beat irregularly and faster than normal.”

Because AFib can cause complications like heart failure or stroke, it is important to consult a healthcare provider if someone isn’t sure what they are experiencing, especially if they are having new symptoms. AFib can cause stroke because it can cause blood to pool in the heart, which can increase the risk of complications like blood clots, according to Dr. Fox.

Symptoms of AFib

• Skipped or fluttering heartbeats
• Fatigue (extreme tiredness)
• Lightheadedness
• Shortness of breath
• Dizziness
• Chest pain

Types of AFib

There are several types of AFib, including paroxysmal, persistent, long-standing persistent, and permanent.

• Paroxysmal: AFib can come and go, typically lasting less than 24 hours, and those episodes start suddenly and stop on their own without medical help
• Persistent: AFib that lasts longer than seven days
• Long-standing Persistent: same as persistent, but lasts longer than a year
• Permanent: AFib lasting more than a year despite medications and other treatments
• Lone AFib can be either paroxysmal or persistent and occurs without associated heart disease

Sometimes AFib comes and goes, so it may not be detected during an EKG, so a patient might have to wear a portable monitor, called a Holter monitor, for a few days or longer to check for any abnormal heartbeats that occur day or night.

“When AFib first develops, it typically starts and stops on its own and can happen infrequently,” says Dr. Fox. “This stage is called paroxysmal AFib.”

He says the longer people have AFib, the more likely it is to progress to persistent. This requires an intervention, including an antiarrhythmic medication or shock, known as cardioversion, to restore the heart to sinus rhythm.

“Chronic AFib is a situation when both the patient and physician decide to no longer try to restore sinus rhythm,” he says. “When AFib is paroxysmal, the success with cardiac ablation is greatest, and the longer AFib is persistent, the lower success is seen with restoring sinus rhythm.”

Tests for AFib

To confirm that you have AFib, you need a thorough medical evaluation. Tell your doctors, who might decide to refer you to a specialist to do tests to find the cause of your symptoms. Your provider or the specialist will review your medical history, do a physical exam, check your pulse and heartbeat and heart rate, and do diagnostic tests, if needed. Those can include an electrocardiogram (EKG or ECG), a noninvasive test that records the heart’s electrical activity.

If someone has AFib, simply feeling for a pulse can strongly suggest its presence by the irregularity of the rate and rhythm. An electrocardiogram (ECG) of the heart will diagnose AFib if it is present during the test. Given the episodic nature of AFib initially, it may sometimes be difficult for patients to obtain an ECG before their symptoms resolve. In that situation a longer-term ECG monitor (Holter or loop monitor) can be worn for up to 30 days to continuously record for abnormal heart rhythms.

Some people may only have symptoms a few times a year, so it makes catching the arrhythmia difficult. There are mobile ECG monitors that people can purchase to obtain an ECG whenever they have symptoms. They can be worn as a watch or portable electrodes (Kardia) where you simply place your fingertips on them to record an ECG.

There are wearable devices, including smartphones and watches, that can monitor your heart rhythm and rate – some will even send a message that you “might” be in AFib, which needs medical treatment to prevent stroke and heart failure.

Treatment of AFib

Treatments can include medicines, procedures, and/or surgery to restore normal heart rhythms, help control symptoms, and prevent complications.

“The first goal of treatment is to determine a person’s risk for stroke with AFib,” says Dr. Fox. “For those individuals with risk factors for stroke – congestive heart failure, hypertension, diabetes, vascular disease, heart attack, prior stroke, being older than 65 – blood thinners are prescribed to prevent blood clots from forming in the heart, which can then embolize (leave the heart) and occlude the blood vessels in the brain, leading to stroke.”

Dr. Fox explains that other medications, called antiarrhythmics, are used to convert AFib back to normal rhythm and prevent it from recurring. In situations where medications are not tolerated, do not work in preventing AFib, or when patients would prefer a more definitive solution, a procedure called catheter ablation is used to prevent AFib from occurring.

“These procedures use heating (radiofrequency), cooling (cryoablation), or pulses of electricity (pulsed field ablation) to destroy the areas of the heart that trigger AFib in most individuals. The success with these procedures ranges from 60 to 80 percent, take one to two hours to perform, and are associated with a low risk of complications,” he says.

How to Manage Anxiety or AFib

Whether you have anxiety or AFib, lowering stress can have a positive effect. Dr. Fox says there are several lifestyle changes people can adopt to get AFib under control:

• Weight loss of at least 10 percent in obese individuals
• Minimize or eliminate alcohol consumption
• Engage in moderate to vigorous physical activity to target 210 minutes per week
• Quit smoking
• Treat hypertension
• Consider screening for sleep apnea and treat it if present

If you think you have AFib or have symptoms of anxiety or AFib, make an appointment with your primary care provider or with Baystate Health Cardiology at 413-794-CARE (2273).