- 4 Ways to Reduce Stress When You Have Atrial Fibrillation
- 1. Yoga
- 2. Biofeedback
- 3. Meditation
- 4. Exercise
- Diagnosing Atrial Fibrillation & Atrial Flutter in Adults
- Transesophageal Echocardiogram
- Chest X-rays
- MRI Scans
- CT Scans
- Exercise Stress Test
- Advanced Cardiac Ambulatory Telemetry
- Implantable Cardiac Loop Recorder
- Genetic Testing
- Electrophysiological Test
- Is it AFib or a panic attack?
- Similarities, differences, and links between AFib and anxiety attacks
- Anxiety or AFib? Understanding the Signs of an Irregular Heartbeat
4 Ways to Reduce Stress When You Have Atrial Fibrillation
Stress is an undeniable part of most of our lives. We’re bombarded daily with myriad reasons to feel stressed or anxious, from political news and financial worries to illness and work woes. Stress is clearly understood to be psychologically taxing, but evidence is piling up that points to its physiological effects as well. One clear example is the way in which chronic levels of stress impact your heart and cardiovascular health overall.
That effect is amplified if you already have a cardiovascular condition. For people with heart arrhythmias like atrial fibrillation, or afib — the most common form of heart rhythm abnormality — stress may trigger or worsen episodes. An estimated 2.1 to 6.7 million Americans have afib, according to the Centers for Disease Control (CDC), and this number is expected to rise as the population ages.
In afib, electrical activity that normally regulates heart rhythm is out of whack, making the upper chambers of the heart beat erratically, says Eric J. Rashba, MD, director of the Heart Rhythm Center at Stony Brook University Heart Institute in New York. Over time, poor blood flow to the area can prompt clots to form, and lead to a far higher risk of stroke.
What does stress have to do with it? Most significantly, stress can exacerbate some of the underlying conditions that cause afib, such as high blood pressure. “People who are under stress are more likely not to eat well or take care of themselves and are prone to the kind of conditions that lead to afib,” says Dr. Rashba, adding that responding to everyday stress by, say, drinking to excess, can bring on an episode of afib, as alcohol consumption is a known trigger for the condition.
Although, as Rashba notes, researching stress’s effect on afib is difficult (it’s impossible in a lab setting to give one group of people stress and make sure another group is not stressed), there are studies that point to a connection, at least to the ways in which stress leads to behaviors that may worsen afib. In a study published in the Journal of Cardiovascular Medicine, researchers looked at 400 people who had experienced an initial episode of afib. Via cognitive tests and patient interviews, they found that acute stress led many to make lifestyle changes, such as overeating and overconsuming coffee, that may have precipitated their episode.
Finally, just having afib, particularly for the long term, leaves many sufferers more depressed and anxious than their same-age peers, found a study published in 2018 in the journal Cardiology Research and Practice. This should prompt healthcare providers to check in with patients to evaluate stress and anxiety levels, and perhaps suggest ways to reduce stress.
To mitigate the effects of stress on atrial fibrillation, it makes sense to find ways to stay calmer and cooler. Here are four research-backed means of doing just that:
It isn’t easy to call to mind the picture of an anxious-looking yogi. There are good reason for that. Yoga training has long been linked to better cardiovascular health, among other physical and mental benefits. In a small study reported in March 2013 in the American Journal of Cardiology, people with paroxysmal afib who practiced yoga twice a week experienced a reduction in afib episodes. Immediately post-training, their blood pressure and heart rate were lower, and overall the participants had less anxiety and improved overall quality of life.
This intriguing practice involves using what’s called “self-regulation” to exert a positive impact on physiological processes, such as heart rate. Think of biofeedback like meditation, but using a monitoring device to help you track your physiological data and use that as a means to train yourself to control your physiological response.
This approach can be used for the management of afib, particularly to control ventricular rate. In a small report published in February 2015 in the Journal of Thoracic Disease that compared the usefulness of various alternative therapies in treating afib, biofeedback training got high marks for its ability to help people decrease their heart rate and potentially manage afib.
We all know people who seem enviably calm and who attribute their ability to stave off stress to the practice of some form of meditation. It seems intuitive that any regular meditative practice would elicit a calming effect, both psychologically and physiologically. Recent research published in May 2018 in Frontiers in Physiology, jointly undertaken by the University of North Texas and the U.S. Army Research Laboratory, zeroed in on a novel way to quantify stress — in terms of heart-rate variability — and thereby to judge how well meditation can reduce it. The study concluded that although various forms of medication are effective at reducing stress in the immediate term, the long-term practice of meditation made positive physiological changes permanent.
There’s no question that regular physical activity can reduce stress. The key to how it works specifically for afib is twofold: First, exercise that leads to even a modest amount of weight loss can help you lower blood pressure and reduce your risk for sleep apnea, two conditions that are major triggers for afib, says Rashba.
“Blood pressure, in particular, when it’s uncontrolled puts increased pressure on the heart over time, causing the muscle to become stiffer and the atrium that’s affected by afib to stretch, and the more that happens, the more often the heart goes into and stays in afib.”
But exercise that relieves stress also may have the benefit of helping you make other, healthier habits, such as drinking less and quitting smoking.
Although there are successful medical treatments for afib, such as medication and ablation — a procedure that cauterizes the faulty electrical connections that lead to episodes — improving the conditions that trigger fibrillation by reducing stress has great promise. Your mind can be your greatest ally in improving your heart health.
The study also found higher levels of anxiety and distress among patients found to have a Type D personality, which is characterized by anger and pessimism. Previous studies have linked this personality type to poor health outcomes and lower quality of life in patients treated for AFib.
Of the 78 patients in the study, 35 were identified as having this type of personality on the distressed personality scale. The researchers suggest that identifying patients with this personality type could help health care providers focus attention on those most at risk for experiencing anxiety, distress or suicidal thoughts.
At least 2.7 million Americans are living with AFib, an abnormal heartbeat that affects blood flow and can lead to stroke, heart failure and other heart complications.
Dr. Dimpi Patel is an internist and researcher at Wilmington Health at New Hanover Regional Medical Center in North Carolina who studies the mind-heart link. “Patients need to be aware that physical ailments can and do have psychological manifestations, and both must be acknowledged and managed to ensure a good quality of life and perhaps even prevent worse outcomes,” she said.
Patel, who was not involved in the study, said the study’s small size limited what could be construed from the findings.
She said that she would like to see studies that look at the impact of different types of psychological therapies on patients with AFib as well as studies that focus on how women with the condition are affected by psychological distress.
Many physical health problems can affect someone’s mental health. “It is important to note that psychological distress, depression, anxiety and, at times, suicidal ideation are not exclusive to atrial fibrillation, but to many chronic diseases such as diabetes, chronic obstructive pulmonary disease and congestive heart failure,” Patel said.
“Physicians have an obligation to broaden their approach in managing any chronic illness to include emphasis on the psychological well-being of their patient,” she added. “To me, it is simply practicing good and compassionate medicine.”
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Diagnosing Atrial Fibrillation & Atrial Flutter in Adults
This test can also help your cardiologist to discover any blood clots, which can lead to stroke, and evaluate the heart’s ability to pump blood, called its ejection fraction. A low ejection fraction may be a sign of heart failure.
During an echocardiogram, a handheld device called a transducer is placed on your chest to send images of your heart to an integrated network of computers in our catheter laboratories.
In a transesophageal echocardiogram, an ultrasound probe is inserted through the mouth and into the esophagus. Because the probe is placed close to the heart, the test can provide clearer pictures of the atria than a traditional echocardiogram. Before the test, you are given a sedative.
This test is necessary to rule out the presence of blood clots in the left atrial appendage or heart chambers.
A chest X-ray uses electromagnetic waves to form images of the heart and chest. It may reveal structural problems or an injury in the heart that can lead to an arrhythmia.
An MRI scan uses a magnetic field and radio waves to produce computerized, three-dimensional pictures of the heart.
This test helps the doctor assess the organ’s structure and how well its valves are pumping blood. An MRI scan can help identify whether heart tissue is scarred, which occurs with some types of cardiomyopathy, a condition that can lead to heart failure.
A CT scan uses X-rays to send three-dimensional, cross-sectional images of the body to a computer. Your cardiologist may use this test to help create a map of the heart that is used during a minimally invasive procedure called catheter ablation.
A chest CT scan typically takes 30 to 45 minutes. You may feel a warm sensation throughout your body if you were given an injection of contrast dye to highlight blood vessels on a computer screen.
Exercise Stress Test
Exercise can trigger a rapid heart rate, so your cardiologist may perform an exercise EKG. In this test, electrodes are attached to your chest to measure your heart rate while you walk on a treadmill, typically for up to six minutes.
Advanced Cardiac Ambulatory Telemetry
These EKG tests record the heart rhythm over a period of time, from 24 hours up to 2 weeks. They can help detect any changes in heart rhythm that may not be revealed during an EKG. You conduct your normal daily activities while wearing these devices, which are removed for showering or bathing.
This small, portable device the size of a smartphone records changes in heart rhythm over a 24-hour period.
During the test, you go about your usual daily activities, except for showering or bathing, while wearing the monitor, which is slung over your neck or attached to your belt or pants as it records your heart rhythm. The monitor connects to sticky electrodes on your chest.
Your cardiologist asks you to keep a diary of your activities while you wear the monitor, recording symptoms such as heart palpitations or chest pain. The next day, you return to NYU Langone, so your doctor can determine whether there is evidence of a heart rhythm disorder.
Ambulatory Telemetry and Remote Monitoring
If your symptoms are infrequent or unpredictable, your cardiologist may suggest you wear this lightweight, portable heart monitor for up to two weeks to measure your heart’s electrical activity.
As with the Holter monitor, the electrodes are attached to your chest to record your heart rate through a wireless device the size of a smartphone. This device sends the data to your doctor via a secure Internet site.
When you notice a symptom, such as shortness of breath or chest pain, you press a button on the device, which records the data. Some devices automatically record irregular rhythms. This information is automatically and wirelessly reported to your doctor for review on a secure website.
Implantable Cardiac Loop Recorder
Because some arrhythmias can occur intermittently, your cardiologist may recommend an implantable cardiac loop recorder, a small device that’s surgically inserted under the skin of the chest to continuously monitor and record your heart rhythm. These monitors can help doctors identify underlying heart conditions.
The device, which is the size of a computer flash drive, is surgically inserted beneath the skin of the upper chest, where it records the heart’s electrical activity. It works automatically or via a hand-held device. After an arrhythmia is diagnosed—or when the device is no longer needed—it is surgically removed.
The battery typically lasts for three years of continuous monitoring.
The Heart Rhythm Center and the Stroke Center have launched a stroke prevention partnership with the Ronald O. Perelman Department of Emergency Medicine and NYU Langone neurologists to identify people who are at-risk and monitor them for atrial fibrillation. Using a new, insertable cardiac monitor called Reveal LINQ™, the smallest implantable cardiac monitor available today, our electrophysiologists can track people with transient ischemic attack 24 hours a day, for as long as necessary to detect an arrhythmia. The device can remain implanted for up to three years.
Because your risk of some types of arrhythmias increases if a family member has such a condition, your cardiologist may recommend genetic testing through NYU Langone’s Cardiovascular Genetics Program. Our experts may recommend blood tests that identify certain changes or mutations in genes, in combination with an EKG, a stress test, and advanced telemetry, to help diagnose a genetic heart rhythm disorder.
During this test, your cardiac electrophysiologist studies the heart’s electrical system to detect any irregularities in heart rhythm using electrode catheters, thin, flexible wires with electrodes at the tip. The catheters are used to send electrical signals to the heart, allowing your doctor to see how the heart reacts to the signals.
In this procedure, which is performed with sedation and local anesthesia, the cardiac electrophysiologist makes an incision in the groin or neck and guides several catheters to the heart through a vein or artery. To guide the catheters, your electrophysiologist uses an imaging technique that uses X-rays, called fluoroscopy, which provides real-time images of the heart.
The cardiac electrophysiologist then sends electrical pulses through the catheters to trigger an abnormal heart rhythm. He or she analyzes the results on a computer to help identify the source of the arrhythmia.
An electrophysiology study takes one to two hours to complete, and most people go home the same day. It is typically performed at the same time as a minimally invasive procedure called catheter ablation.
Is it AFib or a panic attack?
So many common symptoms of atrial fibrillation resemble classic anxiety symptoms that characterize panic attacks: heart palpitations, chest pain, muscle tension, and sweaty palms that come with an adrenaline rush are good examples.
Luckily, these symptoms are generally short-lived, whether it’s an AFib episode or a panic attack. However, in order to treat your body properly and sidestep potential complications down the road, it’s important to distinguish the two conditions.
Looking out for the telltale signs
AFib is notoriously tricky to diagnose on your own, but there are some signs that can help you tell panic attacks and AFib episodes apart. It’s important to keep in mind that the two syndromes stem from different sources: AFib is an electrical disorder that sends a mess of signals through the chambers of the heart, but a panic attack typically won’t have a physical cause. Rather, it’s triggered by events in your environment, stressful situations, or sometimes happens for no apparent reason at all.
Here are a few markers that can help you tell the conditions apart:
Rate of decline. Pay attention to the rate of building and declining symptoms. Since AFib is triggered by a sudden physical event (overactive electrical signals), AFib episodes typically hit suddenly. When the episode subsides, so will the symptoms, but the cycle tends to repeat until treatment is administered. With a panic attack, heart rate can start to creep up as other discomforts manifest, and after the attack hits a peak, heart rate will gradually return to normal as the other symptoms dissipate.
Nature of the heartbeat. The pattern or rhythm of a heart beat can also tell you what’s going on: a panic attack typically brings a constant rapid heart rate, while AFib causes an erratic heart rate. If your heart seems to be skipping beats, or speeding up then slowing down and speeding up again, it’s more likely that AFib is to blame.
Related emotions. Panic attacks often bring what people describe as a sense of doom: a heavy and urgent feeling like something very bad is about to happen. This fear and helplessness is tough to shake and can feed the panic that brought it on. While an erratic heartbeat isn’t pleasant, AFib doesn’t usually bring such a severe emotional response.
Type of pain. AFib and panic disorders can both bring on chest pain as the heart races and muscles tense. A dull chest pain is not uncommon, but everyone experiences pain differently. When AFib hits alongside another heart disorder, the pain can be more specific and intense – and it’s never a good idea to ignore. If you get any chest pain during an attack or episode, see your doctor to investigate further.
Anxiety is a very personal experience, and can be troubling, but take comfort in the fact that it will subside. Unfortunately, AFib may not go away without some help, so you’ll want to make sure you know what you’re dealing with as soon as possible.
Relieve anxiety, reduce AFib
Anxiety and AFib play off each other, and that’s no good for your body or your mind. If you know that anxiety triggers your AFib, make it a priority to get the stressors in your life under control as you craft a more heart-healthy routine.
If anxiety is too much to bear, don’t suffer alone – talk to your doctor about adding anxiety medication to your health management. You may not need to take it every day, only when things get very bad, but knowing that you have something on hand for emergencies can go far to reassuring yourself that you’ll get through the panic should it strike again.
Next, add exercise. Workouts don’t need to be strenuous, but they do need to be regular: you’ll see more positive physical and psychological results when you commit to exercising several times a week. If you’re not sure where to start, you may first want to meet with your doctor and a trainer to measure your current level of fitness, so you can choose an appropriate workout that respects your limits.
Turning a negative into a positive
A panic attack or an AFib episode can bring a rush of frightening energy, as adrenaline courses through your body and your mind jumps to worst case scenarios. You could try to wait it out and distract yourself with an activity, but sometimes it’s impossible to calm your anxious response by sheer will.
Instead, you might try to turn the rush of fear into a rush of excitement: force yourself to think of an exciting event or possibility, or simply start dancing and laughing. It sounds counterintuitive, but you may be able to flip the nature of your feeling from bad to good, and although this probably won’t make your symptoms go away, they will become easier to handle.
Relaxation, support, confidence, and commitment – these are the ingredients of a smart and effective management plan for AFib and for anxiety. If either set of symptoms begins to take over your thoughts and lifestyle, it may be time to seek a new perspective or professional guidance. The good news is that there are plenty of techniques that can interfere with the AFib-anxiety cycle, and help you regain some control.
Anxiety or AFib? Understanding the Signs of an Irregular Heartbeat
One way to determine if what you’re experiencing is atrial fibrillation or anxiety is to understand both sets of symptoms. AFib symptoms may include:
While similar, anxiety or panic attack symptoms may include:
You can see that panic attacks may exhibit more mental or emotional symptoms, such as feelings of unreality or a fear of losing control. These are the symptoms that set panic attacks a part from atrial fibrillation in most circumstances, but it’s still best to consult a doctor if you are unsure whether you may be experiencing anxiety or atrial fibrillation.
Life Line Screening offers an atrial fibrillation screening for those who may be at risk, including those with high blood pressure, overactive thyroid, heavy alcohol or caffeine consumption, those who smoke, have extreme stress or fatigue, have heart disease, lung disease, sleep apnea or diabetes, and those who are obese. If this sounds like you, learn more about our atrial fibrillation screening and take a proactive approach to your health today.