Fear of heart attack

What is heart attack related OCD?

Heart Attack themes in OCD fall under the broader subtype of Health OCD, and they involve fears about heart problems, heart pains, and other health anxieties about issues that could eventually lead to a Heart Attack. Often an underlying fear of death is present.

Someone diagnosed with OCD has the presence of obsessions and compulsions. According to the DSM-5, the Diagnostic and Statistical Manual of Mental Disorders, obsessions are “recurrent and persistent thoughts, urges, or images that are experienced, at some time during the disturbance, as intrusive and unwanted, and that in most individuals cause marked anxiety or distress.” It goes on to further say that compulsions are “repetitive behaviors that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly.”

Compulsions can be physical or mental acts and are done in hopes to reduce the anxiety of the obsession. However these acts are sometimes unrealistic and excessive. Time spent involved in obsessions and compulsions will often be more than an hour a day and could cause significant impairment in “social, occupational, or other important areas of functioning.

People with fear of heart attack themed OCD may notice any “feeling” in their chest and wonder “Is this a heart attack?” People with Heart Attack OCD may take many trips to the doctor or emergency room, eat special diets, avoid exercise, exercise excessively, seek reassurance from friends and family, spend time researching, and avoid any situation that could cause an intrusive thought to occur.

Even with numerous checks that turn out okay, one may worry that the doctor read the EKG wrong or missed a detail, maybe further testing should have been done and wasn’t. They will find contradicting research. A loved one may not give the correct answer or will simply be unwilling to provide reassurance to the OCD sufferer.

Heart Attack OCD Case Example

Michelle is a 45 year old woman who is overweight. In her 30’s she was diagnosed with having benign PVC’s (premature ventricular contractions). This basically means she gets an extra beat once in a while and it makes her feel like her heart is fluttering. She sees a heart doctor for this and with testing has been told her heart is healthy. Her doctors have always suggested she lose weight for optimal health and exercise regularly, which she does not do. 

Lately, Michelle has been worrying constantly that there is something wrong with her heart. When she does this, she immediately researches the symptoms of a heart attack. Though she has done this numerous times, she wants to see if there are any new symptoms that she has not heard of before. Occasionally she will get a brief chest pain (often when she is feeling anxious or panicky).  When this happens, Michelle will either go to the emergency room or will call her doctor and demand to be seen that day for an evaluation.

The other night, Michelle woke up on her right side. She noticed she had a slight pain in her chest. It went away quickly, but now Michelle refuses to sleep on her right side because she attributes that to bringing on the unwanted chest pain. Michelle will not go to sleep unless she puts several pillows next to her to keep her from rolling over on her right side and she has even set an alarm to wake herself up so she can check to see if the pillows are still in the right place.

This fear of sleeping on her right side is causing sleep disturbances for her. If she does wake up on her right side, she feels panicky and quickly rolls back over to the left or to her stomach.  She then says a prayer over and over until she falls asleep, asking for assurance that she is not going to have a heart attack. She has also started researching the best sleep positions for heart health, and she reads these articles over and over. Michelle thinks she will make an early appointment with her heart doctor, even though she has been given a clean bill of health by him just a month ago and a recommendation to come back in one year.

Michelle wants to avoid having a heart attack, or any cardiac related symptoms. Her compulsion of avoiding sleep on the right side, praying, and researching are excessive and interfering in her life.

Heart attack OCD – Common obsessions

• This pain I’m having in my chest must mean I’m having a heart attack.
• My heart is beating too fast, this must be a sign that I’m about to have a heart attack. 
• I might have a heart attack in my sleep and no one will know that I am dying. 
• I might have a heart attack while driving. 
• I have to have phone service at all times in case I have a heart attack. 
• I can’t eat unhealthy foods because they will clog my arteries and lead to heart attack. 
• Intrusive images of themselves grasping their chest in pain and losing consciousness.
• Intrusive images of their funeral after dying from a heart attack.   

People with Heart Attack OCD may be triggered by situations involving anything that brings attention to the heart.  

Common triggers

• Pain or discomfort in the chest
• Fast heart rate
• Heart palpitations
• Exercise where heart rate is accelerated
• Seeing a commercial about heart disease
• Knowing someone who has had a heart attack/died from a heart attack
• Reading an article about health issues.

How can I tell if it’s heart attack OCD, and not anxiety?

First assess if the Member has had a cardiac event in the past. That could be a trigger for developing Health OCD and be an explanation for having heart attack themes in health OCD. Also, assess if the Member has ever had a panic attack. Panic Disorder is the occurrence of a Panic attack followed by fear of having another attack or significant changes in behaviors because of the attack. If there has not been a heart attack or a panic attack, then assess if there are obsessions about the heart or the functioning of the heart followed by compulsions to neutralize the thoughts or images of having a heart attack.  

When people with Heart Attack OCD experience intrusive thoughts, images, feelings, or urges that cause distress, they may feel the need to engage in repetitive behaviors to neutralize the anxiety they feel from the heart attack obsessions. 

Common compulsions performed mentally or physically

• Checking pulse
• Deep breathing to slow heart rate
• Telling someone near that they are experiencing chest pain
• Telling themselves that they are okay
• Seeking reassurance from family and friends
• Going to the doctor repeatedly
• Researching heart conditions, symptoms, and preventive measures.

How to treat fear of heart attack

Example OCD treatment exposures for fear of heart attack

• Running on a treadmill to increase heart rate and then sitting still to really feel that heart race.
• Lying on the floor with a pile of books on the chest to experience the heaviness of chest discomfort.
• Watching videos of people having or even dying from a heart attack. Looking at anatomical pictures of the heart. 

These are just a few examples of what exposures may look like. Exposures will be tailored specifically to the OCD sufferers fears.  Sometimes doctor approval is needed for some exposures, and this can be coordinated by the therapist after a release of information is signed. ERP is the gold standard treatment for OCD.  It is evidenced based and proven to be effective. There is hope for someone who suffers from heart attack OCD. 

If you’re struggling with OCD, I encourage you to learn about NOCD’s accessible, evidence-based approach to treatment with the NOCD care team to learn how a licensed therapist can help. At NOCD, all therapists specialize in OCD and receive ERP-specific training. ERP is most effective when the therapist conducting the treatment has experience with OCD and training in ERP.

We look forward to working with you.