The Heart Attack That Isn’t: Heart Disease Mimics

By James M. Rippe

Studies show that 10 percent to 20 percent of cardiac patients may have symptoms caused not by their heart disease but instead by underlying emotional disorders. Perhaps an equal number of individuals who don’t have heart disease visit their physicians with manifestations of underlying emotional problems that may initially be confused with heart disease. The three most common emotional disorders that can mimic heart disease are

  • Anxiety states: The spectrum of anxiety states extends from chronic anxiety through attacks of anxiety in specific settings. Such anxiety states often may be accompanied by rapid heartbeat, palpitations, chest pain, or tightness or shortness of breath. Although these symptoms need to be taken seriously, a physician typically can rule out serious cardiac disease. Anxiety states typically respond well to support and reassurance, including psychological counseling and therapy whenever necessary.

  • Panic disorder: Although panic disorder is one of the anxiety states, its presentation may be so dramatic and so similar to cardiovascular disease that it deserves separate consideration. Individuals with panic disorder can experience a sudden outpouring of feelings of terror and impending doom.

    These may be accompanied by chest pain, severe shortness of breath, and irregular heartbeat — symptoms that may resemble serious cardiac disease. Attacks often occur in predictable settings, such as crowded rooms, theaters, or other public places where exit may be restricted. A physician typically can distinguish between a panic disorder and serious heart disease. Taking a careful history is important to making the right diagnosis.

  • Depression: Considerable overlap exists between depression and heart disease. Sometimes people who have heart disease become depressed, and in other instances, medicines used to treat high blood pressure or CHD tend to have side effects that may cause depression. Treatment of the underlying depression typically resolves all symptoms in such cases.