Is It Possible To Have Shortness Of Breath And High Heart Rate Due To Anxiety Even Without Feeling Any Anxiousness Or Fearfulness At All?

Posted on Thu, 5 Apr 2018

Medically reviewed by Ask A Doctor - 24x7 Medical Review Team

Thu, 5 Apr 2018 Answered on

Fri, 2 Jun 2023 Last reviewed on

Question : Hi, Doctor. I am in the process of being evaluated because of shortness of breath and high heart rate, which I am having only on exertion. It is directly proportional to my level of exertion (for instance, dressing has less severe symptoms than showering). It has been happening for 4 weeks now and it is with practically any exertion. With relatively significant exertion, it can be pretty bad. My heart rate and breathing recover quickly as soon as I stop the activity. It does not at all feel like anxiety. I cannot even fathom it being related to anxiety. I am not anxious or fearful at all. When I get short of breath, it does not scare me at all. I don't feel like I'm dying. I don't even feel my heart racing (I only know my heart rate because I'm a nurse and take it with a pulse oximeter when I'm short of breath in order to share with the doctor). I just feel like I have been exercising very hard when I have only been doing minimal activity. I feel like someone who is suddenly terribly out of shape. No anxiety or fearfulness whatsoever. None. Not even a little. I'm not overly sensitive to what is happening when I experience symptoms. It's just "normal" now and I know that it will resolve once I stop the activity. Most cardiac reasons have been ruled out with testing. I see a lung specialist next. I am wondering - is it possible to have shortness of breath and high heart rate (with exertion only) due to anxiety even without feeling any anxiousness or fearfulness at all? None. This feels 100% physical. But, I keep hearing "it could be anxiety." I do have anxiety related to phobias (tall buildings, etc) but no panic attacks or anything ever. Thank you.

Answered by Dr. Seikhoo Bishnoi (1 hour later)

Brief Answer:
This could be anxiety.

Detailed Answer:

Hello,

Yes, anxiety can result in symptoms like shortness of breath and high heart rate even when the individual doesn't has any anxiousness or fear symptoms. However, before making anxiety as a diagnosis of these symptoms, other causes should be ruled out.

Cardiac causes have been ruled out as your cardiac evaluation revealed nothing. Respiratory causes should also be ruled out. Generalized weakness could result in such symptoms especially vitamin B12 deficiency, anemia especially of iron deficiency.

In anxiety, sometimes palpitations are seen as the sole presenting symptom. This provokes rapid breathing and CO2 wash out which results in feeling as if there is shortness of breath. To compensate this, rapid breathing is done and deep inspiration is done. This finally leads to a vicious cycle of rapid breathing or breathlessness. So yes, anxiety could lead to such symptoms. Treatment of anxiety should help to settle down the symptoms.

Hope I have answered your query. Please don't hesitate to ask again form more doubts.

Thank you and take care.

Regards,
Dr. Seikhoo Bishnoi
Psychiatrist

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Seikhoo Bishnoi (46 minutes later)

Thank you, Doctor. This makes a lot of sense. However, I do not have the sensation of palpatations. So, while I can understand that the sensation of palpatations could cause the whole cascade of reactions to follow, as you described, what could be the catalyst for all of that when I don't have such a sensation? I can simply walk across the room, perform some very minimal activity, and get short of breath. It feels exactly like I am just really out of shape. I'm not thinking about it at all, I don't feel anything prior (like fear or palpatations), I just feel like I have performed a much more strenuous task than I actuallly did. Its also directly proportional to the level of exertion - walking across the room and doing something very minimal will cause minor shortness if breath, whereas something that requires more exertion will cause more shortness of breath. Just like I would feel if I were extremely unfit. Do you still think this could be caused by anxiety even with no perceived catalyst (such as the sensation of palpatations )? If it can be, I certainly want to know and understand that, so I thank you in advance for your input!

Answered by Dr. Seikhoo Bishnoi (8 hours later)

Brief Answer:
Even in that case, this could be due to anxiety.

Detailed Answer:

Hello again

Anxiety could cause similar presentation but as I mentioned in my last answer other causes should be ruled out. Even if you don't have any palpitations even then that could be anxiety. If you have any ongoing stress or you had anxiety symptoms in past then this could be part of that anxiety.

However, anemia and low vitamin B12 levels should be ruled out before making anxiety as a diagnosis.

Hope I have answered your query.

Thank you.

Regards,
Dr. Seikhoo Bishnoi
Psychiatrist

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar