What happens in the body
When anxious, the sympathetic part of the autonomic nervous system is activated: the pulse quickens, muscle tone increases, and the breathing pattern changes. Frequent shallow breathing reduces the level of carbon dioxide in the blood, hence dizziness, tingling in the fingers, a feeling of shortness of breath and chest discomfort. The chest muscles tense and give a stabbing pain. The person interprets these sensations as a heart attack, anxiety intensifies, and symptoms increase. This creates a stable vicious circle that maintains itself.
- Excessive activation of the sympathetic nervous system
- Hyperventilation and decreased carbon dioxide in the blood
- Intercostal and pectoral muscle tension
- Increased attention to bodily sensations
- Fear of an attack perpetuates symptoms
How to distinguish from heart disease
Pain in cardioneurosis is often stabbing or aching, pinpoint, in the area of the apex of the heart, lasts from several seconds to many hours, is not associated with exercise and often goes away with distraction or movement. Angina, on the contrary, is manifested by pressing pain in the chest, appears when walking or climbing stairs and subsides with rest in a few minutes. However, you cannot diagnose yourself: similar complaints can occur with arrhythmias and with diseases of the thyroid gland.
- Functional pain - stabbing, point-like, of varying duration
- Occurs at rest, often after stress
- Does not increase with walking, may decrease with movement
- Accompanied by anxiety, lump in throat, lack of air
- Angina is associated with exercise and lasts minutes
What examinations are needed
The scope of the examination is determined by the cardiologist based on age, risk factors and the nature of the complaints. Usually they start with an ECG and echocardiography to evaluate the structure of the heart and its function. Daily monitoring helps to catch the interruptions that a person feels and understand whether there is a real arrhythmia. Additionally, hemoglobin, glucose and thyroid hormones are checked, since anemia and thyrotoxicosis give very similar symptoms. If the results are normal, further repeated examinations only increase anxiety.
- ECG with interpretation
- Echocardiography
- 24-hour Holter ECG monitoring
- Stress test for suspected angina
- Complete blood count, glucose, thyroid hormones
- Measuring blood pressure over time
Treatment
The main method is psychotherapy, primarily cognitive-behavioral: it helps to sort out catastrophic thoughts about the heart, reduce introspection and gradually return to normal activity. Breathing exercises with extended exhalation, regular aerobic exercise, normalization of sleep, and reduction of coffee and energy drinks work well. For severe anxiety or panic attacks, the doctor may prescribe drug therapy; You cannot select medications on your own. Endless repeated examinations and “heart” drips without indications do not help, but perpetuate the disease.
- Cognitive behavioral psychotherapy
- Breathing techniques and relaxation exercises
- Regular aerobic activity: walking, swimming, cycling
- Sleep schedule, limiting caffeine and energy drinks
- Quitting smoking and alcohol
- Drug therapy for anxiety as prescribed by a doctor
What to do during an attack
If the cardiologist has already ruled out heart disease, during the next attack it is important not to panic, but to break the vicious circle. Sit down, loosen tight clothing and switch to breathing: inhale through your nose for 4 counts, exhale through your mouth for 6-8 counts for several minutes. It helps to wash your face with cool water, walk around, and switch your attention to any simple action. Don't take your pulse every half minute - it increases anxiety. If the pain is pressing, occurs during exercise and does not go away, act as if you were having a heart attack and call 103.
- Sit down and slow your breathing, lengthening your exhalation
- Do not constantly check your pulse and blood pressure
- Switch attention, walk, drink water
- Do not take heart medications without a doctor's prescription
- Write down the circumstances of the attack for discussion with a specialist
- For typical chest pain, call 103