As I prepare to see the next tele consultation, I notice in the log – A 25 yrs old young man from Chhattisgarh with palpitations. A not so infrequent happening in a telephone consult these days where as a heart rhythm specialist I see more and more young people with these symptoms. He narrated with a lot of anguish that, he has been constantly experiencing pounding in his chest. He had no cardiac issues before and was otherwise healthy. This young man’s lifestyle represents the new normal. He works from home, rarely goes out, off socialisation and reads of pouring statistics of COVID on the internet.
It didn’t take me long to decide this gentleman had no cardiac problem and needed reassurance and few days of medication for his anxiety. A few days ago I had a similar experience with a 30 yrs old lady in home quarantine for COVID. She had episodes of burning sensation in chest, sweating, thumping in chest and tremors of hands. One of her blood pressure readings was high She was very concerned if she had a cardiac problem and practically begged me to investigate and fix her problems. I assured her she wouldn’t need any expensive cardiac investigations.
These cases remind me of the shepherd boy in the story who mischievously alerts his dad to save him from a tiger that never was there. Finally when the tiger arrives, dad doesn’t believe his son and decides not to turn up sadly losing the boy to the tiger.
The pressing of panic button by these young people today is no mischief, on the contrary deserves serious attention by medical fraternity. NO doubt they may not be having cardiac disorders but by no means their symptoms can be ignored or brushed aside. An average person cannot be immune to hoards of COVID related information, economic slowdown, job insecurity, fear of infection and social consequences. COVID affects not only the physical health but also mental wellbeing of general population. A recent research paper, with compilation of data from 5 studies involving about 9000 patients, showed that in general population in COVID times, the prevalence of anxiety was 30% and depression 33%. People who follow COVID-19 news the most, experience more anxiety as they read more negative statistics and also more exposed to false information in media . The levels of anxiety, depression and stress are significantly higher in the age group of 21–40 years. The main reason for this seems to be that this age group are concerned over the future consequences and economic challenges caused by the pandemic, as they are key active working forces in a society and are, therefore, most affected by downsizing and job losses. Women are more prone for stress while those with highest education are increasingly susceptible to anxiety. Those with chronic illnesses and who have aa family member affected by COVID are prone to negative thoughts and poor mental health. Those who are quarantined for COVID are also affected by stress, fear, and panic. Social isolation, unproductive days, negative thoughts, uncertainty all lead to anxiety sometimes manifesting as palpitations.
Stress and anxiety themselves can worsen the immune system making them more prone for infection. Anxiety and depression can by themselves lead to cardic problems. A rare kind of heart failure is described in some people who experience intense grief where heart balloons out . This is called as tsakatsubo cardiomyopathy initially described in Japan but seen elsewhere too.
False alarms may be activated by anxious individuals yet rhythm disorders do exist in a proportion of these patients. COVID can cause cardiac injury and heart problems can be seen in 6-20% of these patients. It’s important to identify these rhythm disturbances as they need specific treatment. Heart rate in anxiety and panic also go fast but these rarely go above 120/minute. An ECG shows normal rhythm but at a higher rates (Sinus Tachycardia). In contrast rhythm disorders causing fast rates occur episodically with heart rates from 150-200 per minute. Unlike anxiety related fast rates, they do not persist the whole day. ECG during episodes is vital in diagnosis of these disorders and distinguishing from normal rhythm.
Government and Health officials need to take efforts to disseminate correct figures and positive news of the disease and prevent misinformation from spreading. They need to instil confidence and psychological security through digital and other media. Positive thoughts and optimism quells depression and anxiety.
(Disclaimer: The author is Dr Hygriv Rao Senior Consultant Cardiologist KIMS Hospitals. Views expressed are a personal opinion.)