Cardiophobia (Fear of Heart Attacks): Definition, Symptoms, & Treatment

What Is Cardiophobia?

Cardiophobia is a specific phobia in which an individual has an irrational fear that they will have a heart attack. People with this phobia lose insight that the symptoms they are experiencing, such as shortness of breath, are due to anxiety and instead conclude that the symptoms are due to a heart attack. Cardiophobia is a type of pathophobia, which is the fear of death.

It is common for people with cardiophobia to seek medical treatment, which includes making excessive medical appointments. The distress associated with acute somatic symptoms in people with anxiety disorders, including cardiophobia, are frequently treated in emergency departments, by primary health care providers, or in mental health care settings.⁶

Cardiophobia & OCD

Individuals with cardiophobia have persistent, unwanted, and intrusive thoughts about heart-related issues, which is considered an obsessive-compulsive disorder obsession. People with cardiophobia try to resolve or suppress the anxiety and emotional responses to the obsessions by performing compulsive behaviors. Compulsions of cardiophobia include checking heart rate/pulse, seeking unnecessary medical attention, surfing the internet for information, and avoiding strenuous activities.

Cardiophobia Vs. Hypochondria

Cardiophobia and hypochondria differ because cardiophobia is a specific phobia, whereas hypochondria is a non-specific phobia. Hypochondria involves the fear of contracting a non-specified illness or illnesses, and individuals with this phobia can have a range of phobias. In contrast, people living with cardiophobia do not complain about multiple symptoms but are afraid of suddenly dying due to the malfunction of their heart.⁷

How Common Is Cardiophobia?

A study found that approximately 30% of new patients visiting a cardiologist had symptoms of non-cardiac chest pain (NNCP) due to panic disorder, depression, and anxiety.² Cardiophobia accounted for 2% to 5% of emergency department visits.^3,4 Even after being reassured that nothing is wrong, up to 80% of patients with NCCP report long-term chest pain, functional impairment, and psychological distress.⁵

Signs of Cardiophobia

Signs of cardiophobia can involve changes in lifestyle and overall functioning. People often use devices to scan their physiological sensations as a checking behavior. They may ask others to check their pulse or ask for reassurance that they are healthy, which can start interfering with their relationships’ quality.

Visit Doctors & Specialists Frequently

Obsessive doubt leads sufferers to compulsively check their heart health through frequent medical appointments or “doctor hopping .” Despite test results, people still feel unconvinced of their accuracy. One study reported that such medical attention leads to frequent direct and indirect costs to the health insurance system.¹⁰

Constant Monitoring of Heartbeat

People with cardiophobia compulsively monitor their heartbeat to check for signs of irregularities which, in turn, alter the heart’s normal rhythm and produce the effect they’re most worried about discovering. Some people check for symptoms of tachycardia (rapid heartbeat), bradycardia (weak heartbeat), or angina (chest pain). The checking behavior often leads to panic attacks that cause the person to believe their obsessive fear is happening.

People with cardiophobia typically seek continuous reassurance and support from significant others and avoid activities believed to elicit symptoms.⁸ Recurrent chest pain, continued fear, and enduring preoccupation about heart issues cause personal discomfort and have devastating consequences on the individual’s social and occupational life.⁸

Avoidance Behaviors

During the progression of a cardiophobia episode, people often develop avoidance behaviors to lower the risk of triggering a heart event. People refrain from taking chances with physically strenuous or stressful activities. They may stay close to home and avoid traveling out of the range of an emergency room. They may forego valued leisure activities such as gardening, yard work, or walking with friends. These behaviors begin to limit lifestyle choices and interfere with family and social relationships and participation in important events. The quality of life of 36% of research participants reported having a much lower quality of life due to the problem.¹¹

Continuous Sharing of Fears With Others

Because people with cardiophobia are so obsessed with the problem, they may talk about it excessively to other people to get reassurance, or that it’s simply on their mind all the time. It can become tiresome for others when this is the only topic the sufferer is interested in talking about because it feels so life and death. People will try to be sympathetic but may become less patient, annoyed, or involved in the obsession by giving constant reassurance over time.

Perpetually Seeking Reassurance

A factor largely responsible for the persistence of the problem is anxious heart monitoring when experiencing stress and arousal. Despite repeated negative medical tests,  people with cardiophobia continue to believe and ruminate in an almost obsessive fashion that they suffer from a life-threatening heart problem. These subjects typically seek continuous reassurance and support from significant others and avoid activities that elicit symptoms.⁹

Cardiophobia Symptoms

Symptoms of cardiophobia share the same symptoms of panic attacks caused by the phobia. People with a primary diagnosis of cardiophobia may secondarily meet the criteria for panic disorder and vice versa.

Common symptoms of cardiophobia include:

• Shaking
• Sweating
• Rapid heartbeat
• Chest pain or tightness
• Dizziness
• Shortness of breath
• Feelings of numbness
• Feeling faint

Heart Attack Vs. Panic Attack

Symptoms of a heart attack versus a panic attack have important similarities. Phobia-related anxiety activates the sympathetic nervous system that alerts us to danger, despite no evidence of a threat. This causes physiological symptoms such as chest pain, palpitations, and dizziness. These overlapping symptoms create a circular fear loop; worry about a heart attack can result in a panic attack, and the person can then interpret the signs to mean they have a heart attack.

Cardiophobia Diagnosis

Cardiophobia may be challenging to diagnose in the beginning phases. Primary care physicians may refer people with this disorder to a cardiologist who will run tests for heart problems. Frequent calls or requests for visits suggest a pattern of anxiety that may indicate the problem is psychological, and a recommendation may be made to seek mental health support.

According to the DSM-5, the criteria to receive a cardiophobia diagnosis include:

• Intense fear or anticipatory anxiety about having a heart attack
• The fear is disproportionate to the person’s triggering physiological functions
• The anxiety causes distress and impacts other areas of the person’s life
• The person seeks to avoid the situation that causes distress
• The person excessively gathers information about heart disease or makes frequent medical appointments

Difference Between Cardiophobia & Heart Problems

The difference between cardiophobia and heart problems lies in the results of medical tests. Many people who are concerned about their heart health may be referred by their doctor for testing. Typically, people accept the results, but people with cardiophobia continue to have doubts and continue to find evidence to prove a heart-related problem.

Effects of Cardiophobia on Daily Life

The quality of life for people with cardiophobia can become very limited. They may feel that being away from accessible medical care will leave them vulnerable to a heart attack.  Their awareness becomes focused on internal sensations more than the external reality around them. The preoccupation can interfere with social interactions and work productivity and create social isolation.

Unfortunately, people who perform avoidance behaviors forego heart health activities that can prevent heart problems. When life becomes more sedentary and isolated, people are left with obsessive thinking about their heart which can cause the episodes of panic to become more severe. A study indicated that 30–60% of NCCP patients experience work interference or take sick leave.⁷

Cardiophobia Treatment Options

While there are no specific treatment protocols for cardiophobia, it can be addressed by the same techniques and strategies as other phobia treatments. Skills effective for anxiety disorders, such as panic disorder, generalized anxiety disorder, and obsessive-compulsive disorder, are easily transferable for treating cardiophobia.

Behavioral treatment modalities are the recommended way to treat cardiophobia. Although they can seem counterintuitive, since they directly confront the fear, they are incredibly effective. When people confront and challenge their fears, they become less afraid of having the symptoms and can let them run their course.

Treatment options for cardiophobia include:

Cognitive Behavioral Therapy

Cognitive behavioral therapy (CBT) helps people identify their distorted beliefs and ways to reframe the cardiophobia experiences and episodes. The cognitive distortions common to cardiophobia are jumping to the worst conclusions, such as “What if I really have a heart attack this time?” and catastrophizing, such as “What if these symptoms never go away?”.

Exposure & Response Prevention Therapy

Exposure and response prevention (ERP) involves people engaging in obsessive feared physical or mental situations while resisting urges to perform reassuring or avoidant behaviors. This technique is effective because it creates biochemical changes in the brain. Staying in the situation allows the anxiety during the triggering episode to rise and drop off. People may practice reading an article on cardiac arrest while resisting urges to body scan, check their pulse, or ask for reassurance from their therapist, then conduct the exposure alone with no one home.

Interoceptive Exposure Therapy

Interoceptive exposure involves the patient purposely inducing the feared physical sensations by doing physical exercises that bring on the feared physiological sensations. Examples might be having the person spin around in a swivel chair, holding their breath, twirling around, standing up, and hyperventilating. This strategy works by mass repetition of the feared physiological symptom, being in control of having them, getting used to them, and then no longer being afraid of them.

Medication Treatment

Medication can help alleviate the symptoms of cardiophobia. Since cardiophobia is considered an anxiety disorder, medications for anxiety are often prescribed. The most commonly prescribed medication is antidepressants. Other medications prescribed cautiously are benzodiazepines, which are faster-acting than antidepressants but can become addictive. Beta-blockers work to stop the adrenaline flow that causes the fight or flight symptoms.

How to Cope With Cardiophobia

Living with cardiophobia can be immensely taxing, but there are healthy ways to cope. In addition to therapy and medication, individuals can help their symptoms of cardiophobia by using healthy coping skills.

Coping skills to try for cardiophobia include:

• Diaphragmatic breathing: Diaphragmatic breathing works to regulate the sympathetic (fight, freeze, flight) to the parasympathetic nervous system (rest and relaxation). You can’t physiologically have a panic attack while breathing diaphragmatically!
• Grounding skills: Grounding skills help bring you back to the moment by performing soothing behaviors. Listening to calming sounds (*rain, a gong, the ocean, etc.), listing a category of items alphabetically (food, countries, names, etc.).
• 54321 Method: The 54321 method brings your attention to the present moment with descriptions of what is in the environment using sight, touch, taste, smell, and sound.  This technique is extremely effective because the person is taking control of their immediate experience that is safe and real.

When to Seek Help for Cardiophobia

Seeking help for cardiophobia is indicated when the fear of a heart attack distracts people from normal functioning. The sooner someone finds support, the less toll it will take on their health and quality of life. People can find a therapist through online therapy platforms and an online therapist directory that will guide them to a CBT therapist. The therapist can help the person uncover the underlying causes of their phobia, help the person address them, and learn healthy ways to cope with triggers and stress. The therapist can steer an individual away from using avoidance coping strategies by having them gradually enter the feared situations through CBT and ERP strategies.

In My Experience

Treating OCD and related anxiety disorders, cardiophobia is very treatable. The first step is providing psychoeducation about the problems and treatment strategies. Once the person understands and accepts the nature of the problem, they become more willing to face the triggering and avoid the situation without performing compulsive rituals. When people are willing to undergo the exposure tasks, it doesn’t take long before they begin experiencing relief and freedom from fear. Because anxiety disorders are neurobiologically connected, behavior therapy, and CBT strategies, work by recalibrating the brain’s chemical functions. While it takes some courage and perseverance, you will be amazed by your ability to resume life more normally. You may still have thoughts about having a heart attack, but you will respond to those thoughts more objectively, less emotionally.