The Rationale for, and Use of, Benzodiazepines in Cardiac Conditions

Anxiety disorders can be challenging to diagnose in patients with cardiovascular disease who often suffer from chest pain or tightness, shortness of breath, fatigue, dizziness, rapid heart rate, and other symptoms that overlap with those of anxiety. Benzodiazepines (BZs) are efficacious for the treatment of anxiety; they reduce catecholamines, lower coronary and vascular pressures, and mitigate muscle spasms that often contribute to cardiac symptoms. BZs are efficacious in those with panic disorder and panic associated with arrythmias, implantable cardioverter defibrillators, dyspnea, or unrelenting anxiety that threatens treatment adherence. The short-term risks of BZs are primarily related to their central nervous system depressant effects, which contribute to falls and confusion, especially in older individuals. At higher doses, BZs can precipitate respiratory depression, hypotension, bradycardia, and atrioventricular block.