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Anxiety don't cause heart attack directly. Instead it increases the risk of heart attack. Anxiety occurs individual in stages of extreme stress and tension.
In stages of stress there occur change in metabolism. The carbohydrates start converting into lipids (lipogenesis) and also over all levels of HDL (High Density Lipoprotein, it is a beneficial lipid) decreases and cholesterol levels increases. Due to dyslipidemia the excess lipid start accumulating in blood vessels also called as atherosclerosis. Atherosclerosis is main cause behind heart attacks. Atheromatous plaques dislodge from blood vessels and they may occlude the vessels of heart and resulting in heart attack. But this thing happen in chronic long standing anxiety for years.
Other reason is in stages of stress excess work is done by heart to pump blood. Due to chronic stress on heart hypertrophy of left side of heart occurs. In hypertrophy any decrease in blood supply may precipitate heart attack.

Thanks, if you have more questions you can ask again.

Dr. Seikhoo Bishnoi, MD

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