Medically reviewed by Jill Johnson, FNP
Written by Our Editorial Team
Last updated 1/3/2022
For those who have experienced it, chest pain can be, well, anxiety-inducing.
Is it a heart attack? Do you need to call emergency services?? Should you wake up your sleeping partner? Do you just generally panic?
The truth is, according to the Cleveland Clinic, there are many possible causes of chest pain, from scary ones like coronary artery disease to less scary ones like a sprained chest muscle.
In fact, chest pain is reported by the Official Journal of the Association of Medicine and Psychiatry to be experienced by 12 percent to 16 percent of people, with the chances for it continually increasing after age thirty. However, we’re here to talk about just one cause — anxiety.
Let’s talk about how anxiety can cause chest pain, what it feels like and what you can do to stop it in its tracks.
If you experience chest pain, your mind might immediately jump to numerous movie scenes where a character grabs their chest and falls to the floor dramatically, clearly in the midst of heart attack symptoms.
However, while chest pain is the second most common reason for visits to the emergency room, not all chest pain is caused by a heart attack.
In fact, according to the Primary Care Companion to the Journal of Clinical Psychiatry, up to one-quarter of patients with chest pain have panic disorder, a type of anxiety disorder.
Other anxiety disorders include generalized anxiety disorder and a variety of phobias, but chest pain isn’t unique to any one of them.
According to the American Psychiatric Association, in order for a person to receive a diagnosis of an anxiety disorder, their fear or anxiety must be out of proportion to the situation, inappropriate for their age or hinder their ability to function normally.
In and of itself, anxiety is a completely normal reaction to stressors in our environment. Many sources of stress can lead to feelings of anxiety, from a fight with a partner to a hard day at work. It’s all part of our emotional regulation, says the American Psychiatric Association.
Among mental disorders, anxiety disorders rank as the most common, with symptoms of anxiety affecting nearly 30 percent of adults at some point in their lives.
Overall, anxiety can present physically with a number of common symptoms, including nausea, shortness of breath, muscle aches, stomach pain and headaches.
The truth is, while a healthcare professional may examine you and find nothing amiss with your physical body, your mental health can have very real physical effects, according to Harvard Medical School.
This is all thanks to your autonomic nervous system.
This system is responsible for ensuring you stay alive by controlling things like your breathing, blood flow and heart rate, without you needing to think about any of it. It’s also responsible for your fight or flight response, which ensures that you remain ready to respond to dangerous situations.
Anxiety and stress can falsely activate your flight or fight response even when you’re not in immediate danger — leading to physical symptoms like a panic attack, heart palpitations, hyperventilation, or related chest pain.
Now, while chest pain can be the result of anxiety rather than a heart attack or other forms of heart problems, it’s important to know that over time, the way your body reacts to anxiety can put a strain on heart health.
Anxiety has an association with the occurrence of heart disease, and, according to the journal Current Psychiatry Reports, in some cases it can contribute to progression, as well.
Cardiovascular diseases that may have an association with anxiety include high blood pressure, coronary heart disease, rapid heart rate and minimization in the body’s ability to properly adjust heart rate, according to Johns Hopkins Medicine.
The next question is obvious. If both anxiety and heart disease can cause chest pain, how do you know when to head to the emergency department or make a call to your healthcare provider?
Let’s get some basics out of the way first. You know your body best. So, if you’re experiencing chest pain that is new to you, don’t hesitate to contact your provider or seek immediate assistance from an emergency room. In the case of a heart attack, time is of the essence.
But, here are some tips on how to tell the difference between chest pain that has originated from anxiety versus a heart attack.
Non-cardiac chest pain that is caused by anxiety fundamentally feels different than the pain caused by a heart attack. It will:
Feel like a sharp and stabbing sensation (uncommon with heart attacks) that lasts only five to 10 seconds.
Become more or less severe with movement or pressure applied to the chest.
Be concentrated in one small area.
Usually occurs when you haven’t been moving or exerting yourself.
In contrast, cardiac chest pain caused by a heart attack may:
Worsen in severity over the course of a few minutes
Occur during exercise or other types of physical exertion (but can also be brought on during rest).
Feature a consistent pain or pressure in the chest. Patients with chest pain describe a feeling of fullness rather than the stabbing pain you might experience during a panic attack
May be accompanied by pain that spreads to other parts of the body such as the arms, shoulders, jaw, throat or abdomen
Conditions like generalized anxiety disorder or panic disorder are not all-or-nothing conditions. Think of them more as having building blocks.
When you start to experience physical symptoms from your anxiety, that’s your body telling you that your stress has built to a point where it needs to be reduced.
Here are some techniques from the American Heart Association that can help when you experience anxiety.
When you’re experiencing chest pain from anxiety, take a moment to sit down and practice some breath work. Focusing on your breath is a great way to trigger your body’s relaxation response.
Try deep breaths by taking air in through your nose, holding for a bit and then breathing out through your mouth. Rinse and repeat a few times.
Your mental health provider will have the skills to guide you in navigating your anxiety. From cognitive behavioral therapy, to medication, there are a number of options available for helping you get your anxiety under control.
Chest pain is understandably a cause for concern. While chest pain from an anxiety attack may be less impactful in the moment than pain from say, coronary artery disease, it is still a valid health condition and important to address in order to reduce long term risk factors.