Can Anxiety Cause Chest Pain?

Have you ever experienced chest pain when feeling anxious? Your chest may begin to tighten, and you might experience persistent pain and heart palpitations. It’s often uncomfortable and can be scary. There may be several possible causes of this type of acute chest pain, and chest pain is often a symptom of anxiety. In addition, some peer-reviewed studies have found that people who frequently feel anxious may be at greater risk of heart attacks and other acute coronary syndromes. A combination of therapy, medication, and lifestyle changes is often effective in treating anxiety and the chest pain that can come with it. Connecting with a licensed therapist through an online therapy platform can be an excellent place to start your journey toward appropriate medical treatment.

In general, you should always take chest pain seriously. If you think you're having a heart attack or other medical emergency, please seek medical attention immediately by calling 911 or going to a hospital emergency room. 

If you struggle with anxiety chest pain, we'll discuss tips to help you learn to manage and overcome it later in this article. For example, certain types of therapy, such as cognitive behavioral therapy (CBT), can often treat patients with anxiety who experience excessive worry or other symptoms.

It's usually safest to be aware of the signs of a heart attack and seek emergency care if you or someone around you has symptoms. Trained healthcare professionals can evaluate symptoms and determine whether you are experiencing chest pain due to anxiety or an emergency requiring medical care. 

Women and older people are more likely to experience atypical symptoms of coronary artery disease, which may include extreme fatigue, shortness of breath, a dull ache or pain in the neck, jaw, arms, stomach, or back, and muscle tension that can feel similar to a pulled muscle. In some cases, physical exertion can activate the sympathetic nervous system and cause chest pain. 

Other organ systems, such as the digestive and musculoskeletal systems, may also be related to chest pain, highlighting the significant differences between various medical conditions that may cause someone to think they're having a heart attack. For example, an inflammatory disease of the cartilage in the chest called costochondritis can cause chest pain that worsens with deep breaths and may be mistaken by patients for heart attack symptoms. 

Is anxiety to blame?

Yes, anxiety can cause chest pain. Studies on repeat visits to the emergency department have found that many people with sudden chest pain also experience frequent anxiety. Chest pain from panic or acute anxiety attacks can result from a sudden stress response, also called a fight or flight response, which events in everyday life may trigger.

One study states that physicians should always consider anxiety disorder in patients presenting to the emergency department (ED) with chest pain after ruling out physical medical conditions. It also notes that a patient's definition of atypical pain, recurrent admissions to the ED, and symptoms such as dizziness, chills or hot flashes, and fear of death could aid in identifying anxiety disorder as a cause of chest pain. 

More specifically, chest pain is often associated with a specific type of anxiety disorder called panic disorder. Patients experiencing such chest pain during a panic attack may mistakenly believe they are having a heart attack, which can further intensify their anxiety. Therefore, it is key to distinguish between the warning signs of anxiety or panic attacks and heart attack pain.

Anxiety disorders are generally classified in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as conditions characterized by excessive worrying and intense fear. Mental health conditions covered in this classification can include:

• Anxiety disorder due to another medical condition: Symptoms of severe anxiety caused by a physical health condition.
• Agoraphobia: Extreme or irrational fear of being in open or crowded places, leaving one's home, or being in areas that are challenging to escape.
• Generalized anxiety disorder: Excessive anxiety about various aspects of your life.
• Obsessive-compulsive disorder (OCD): Unwanted and disturbing thoughts which can lead to a display of repetitive or compulsive behavior.
• Other specified/unspecified anxiety disorder: Anxiety or phobias that don't meet the criteria for other anxiety disorders.
• Panic disorder: Displayed as panic attacks brought on by imaginary terrors.
• Social anxiety disorder (or social phobia): An intense fear of being judged and rejected by others.
• Illness anxiety disorder (previously hypochondria): Irrational belief that minor (or non-existent) symptoms are a sign of serious illness.
• Selective mutism: An inability to speak in specific social settings, like work, school, or community.
• Separation anxiety disorder: Separation from someone to whom you feel a strong emotional attachment causes excessive anxiety.
• Specific phobia: Fear of particular objects, animals, places, or activities.
• Substance/medication-induced anxiety disorder: Anxiety caused by exposure to alcohol, drugs, or medication.

Left untreated, anxiety disorders can lead to complications over time, like increased heart rate and blood pressure, which may increase your risk of coronary heart disease and other related conditions. It’s important to seek the appropriate medical treatment to help reduce anxiety symptoms.

Treating anxiety-related chest pain

Chest pain is often associated with panic disorder. However, panic disorder is usually treatable when patients find a solution that suits them. Here are a few effective options you can try to help prevent or manage panic attacks.

Therapy 

An anxiety treatment plan may often involve cognitive behavioral therapy (CBT), in which a patient normally learns new ways of thinking about and reacting to their anxiety triggers. Research has shown that in-person and online CBT can help manage and reduce symptoms of panic disorder and related mental health concerns. For example, everyday social interaction can become less daunting as individuals apply CBT techniques to manage feelings of anxiety in social settings.

Online therapy

If you’re experiencing an anxiety attack on most days of the week, you may find it overwhelming to search for a provider that is taking on clients, travel to a new location for a therapy session, and meet with a stranger face-to-face. Online therapy can lessen some of these challenges and empower you to get professional help from the location where you feel most comfortable.

Medication

Lifestyle changes

Chest pain caused by panic attacks may improve with changes in diet, exercise, and other daily routines. For example, caffeine consumption is often linked to increased panic attacks and anxiety symptoms. If you consume caffeine regularly, consider reducing your intake to one or two cups of coffee in the morning (or eliminating it altogether) to see if your symptoms improve.

One study showed that five cups of coffee could induce a panic attack in many of those diagnosed with panic disorder. Another showed that excessive caffeine consumption could worsen anxiety symptoms and lead to poor treatment responses. 

• Meditation and stress management techniques
• Getting sufficient restful sleep
• Increased daily physical activity
• Eating a nutritious diet 
• Exercising or working out regularly
• Practicing yoga, tai chi, or qigong
• Avoiding alcohol, caffeine, and nicotine