A practicing cardiologist quite often encounters a small percentage of patients whose primary reason for consultation is reassurance that they do not suffer from any cardiac ailment. Their symptoms may be vague, their test results normal, and their risk profile modest. Yet their distress is real. They are not seeking procedures or prescriptions as much as they are seeking certainty in an uncertain world.
Interestingly, this group represents only one end of a broad behavioral spectrum. A large majority of the population still chooses to remain blissfully unaware of disease, carrying on unabashedly with lifestyles that ignore stark risk profiles. Unbalanced diet, sedentary habits, smoking, uncontrolled blood pressure and diabetes, just to name a few. On the other hand, a smaller but steadily growing cohort of patients has begun to actively engage with their health, seeking early detection and prevention. This shift is, without doubt, a positive marker for any developing society. Awareness, when balanced, saves lives.
I have often written in the past about the merits of preventive health checks, riskfactor awareness, and mitigation as measures to avoid the shock of unannounced or advanced disease. Prevention is not merely a medical strategy; it is a mindset. Knowing one’s blood pressure, cholesterol, blood sugar, and family history, and acting on that knowledge, can dramatically alter long-term outcomes. But as with most things human, behavior exists on a continuum.
Entire Spectrum: Careless to Anxious
Human responses to disease or its risk factors range from careless and carefree, through careful and concerned, all the way to anxious and frankly hypochondriac. While being careless is obviously irresponsible, the states of being carefree, careful, and concerned may, each play a role in overall wellbeing. Carelessness and carefree living often define youth whereas carefulness and concern typically arrive with maturity. It is the anxiety response, however, that can become counterproductive.
It is heartbreaking to see concern mutate into persistent fear, vigilance turn into obsession, and health-seeking behavior becoming healthconsuming, particularly in a younger population, which should have otherwise been carefree.
The incidence of such presentations is justifiably and noticeably higher in the post COVID era or among patients who have encountered sudden cardiac events among friends and family. The pandemic exposed millions to relentless health-related news, sudden losses, and unpredictable outcomes. These experiences have left psychological imprints. For some, every palpitation now feels ominous; every fleeting chest sensation signals catastrophe. The collective trauma of recent years has undoubtedly sharpened health anxiety, making obsession about cardiac health more common in everyday practice.
Chronic anxiety is an ailment
Short term anxiety about anticipated situations is often an adaptive response, helping humans achieve better outcomes in life. Chronic anxiety, when pathological, is however a medical condition in its own right and deserves targeted treatment. The medical basis of anxiety is well established, and its ill effects are far-reaching. Chronic anxiety keeps the body locked in a state of heightened alert, activating stress pathways that were designed for short bursts of survival, not for continuous operation. Over time, this constant “fight or flight” mode exacts a significant biological toll.
At the neurohormonal level, anxiety is driven by persistent activation of the hypothalamic–pituitary–adrenal axis and the sympathetic nervous system. Stress hormones such as cortisol and catecholamines flood the bloodstream. Neurotransmitters like norepinephrine and alterations in serotonin signalling amplify vigilance and fear. What should be a transient adaptive response becomes a chronic maladaptive state, rewiring neural circuits toward hyperresponsiveness and threat perception.
From a cardiovascular perspective, the consequences are tangible. Anxiety itself can reduce cardiac efficiency by increasing resting heart rate and myocardial oxygen demand. It raises blood pressure through sustained sympathetic activation and vascular constriction. It contributes to deranged blood sugar by promoting insulin resistance and stressinduced hyperglycemia. Sleep becomes fragmented, recovery is impaired, and inflammatory markers rise. Over time, this internal milieu predisposes individuals to hypertension, metabolic syndrome, arrhythmias, and ultimately, a higher risk of cardiac disease. Ironically, in trying desperately to avoid heart problems, the anxious patient may be creating the very conditions that foster them.
A related entity worth mentioning is “cardiac neurosis”. It is a condition in which patients are convinced they have heart disease despite repeated normal evaluations. Chest discomfort, palpitations, breathlessness, and fatigue are interpreted through a lens of fear. The heart becomes the focal point of distress, even when objective evidence suggests otherwise. Cardiac neurosis sits at the intersection of cardiology and psychiatry, and managing it requires collaboration, patience, and empathy.
The Anxious One
A typically anxious patient is quite easy to recognize. Persistent health-related worry, preoccupation with normal bodily sensations, excessive monitoring of vital signs, reluctance to accept normal test results, repeated consultations with newer doctors (while often hiding previous opinions from them) are all red flags. Such patients seeks multiple consultations, often from different specialists. They like to elaborate each symptom, every sensation, every fluctuation in pulse or pressure and will use multiple technological tools from smartwatches, blood pressure monitors, glucometers to even portable ECG devices. Reassurance does not reassure them and they dread hearing that there is no serious cardiac ailment.
What can be done?
We must recognize two facts: firstly, that chronic anxiety, by itself, can result in a cardiac condition and secondly, that the management of this condition is different from a cardiac disease. Hence, recognition of anxiety by doctors and family members is crucial. The mistake often made in these situations is to keep treating the symptoms – another ECG, another echo, another blood test – rather than addressing the underlying disorder.
Treatment of anxiety disorders is multifaceted and highly effective when approached systematically. Psychoeducation is the first step – helping patients understand the mind body connection and the physiological basis of their symptoms. Cognitive behavioral therapy plays a central role by identifying distorted thought patterns and replacing them with more balanced interpretations. Lifestyle interventions really help. These include regular physical activity, structured sleep, mindfulness practices, and reduction of stimulants such as caffeine. In moderate to severe cases, pharmacotherapy with anxiolytics or antidepressants may be indicated, always tailored to the individual and monitored carefully. Most importantly, care must be coordinated. Cardiologists, primary physicians, and mental health professionals working together, sending a unified message that treats the disorder rather than endlessly chasing its manifestations.
The best state in life is to try and remain somewhere between carefree and careful when young and to transition to careful and concerned with advancing age. But the state should never tip into anxiety or hypochondria. Fear and paranoia are poor long-term friends. Ultimately, health is about balance. While one must adopt a conscious strategy that prompts sensible screening, risk-factor control, and thoughtful lifestyle choices, it is also good to remember that que sera sera (whatever will be will be) as the final mantra of life has an important role. It does not imply doing nothing. It just means doing what is in one’s control. Eat well, move often, sleep enough, manage stress, and seek preventive health care at a sensible frequency. Beyond that, learn to let go. A calm mind is not just a psychological luxury; it is a cardiovascular asset.
Prof Hemant Madan is an Interventional Cardiologist and Programme Head, Cardiac Sciences for Narayana Health
