Cardiac symptoms and anxiety disorders: contributing factors and pharmacologic treatment

Abstract

Anxiety may have deleterious effects on the cardiovascular system in persons who have, or are predisposed to have, cardiovascular disease. Contributing factors consist of the type of anxiety, constitutional characteristics and personality traits. The treatment of anxiety thus has a beneficial effect on patients with cardiovascular disease. However, anxiety reduction through medication, even if it includes subjective improvement in somatic symptoms, should not necessarily be equated with beneficial effects on the cardiovascular system. Three groups of medication used in the treatment of anxiety have different effects. Antidepressants lower psychic anxiety but may have the opposite effect on the cardiovascular system, whereas beta-adrenergic blockers lower sympathetic tone without affecting psychic anxiety. Only benzodiazepines fulfill both functions. Since subjective reports of somatic, including cardiovascular, changes correlate poorly with physiologic changes, assessment of new medications should not rely on self-reported improvement in cardiac symptoms but should include objective measures as well.