We all experience stress, nervousness, anger and fear at times and these motions can cause a host of symptoms. From rapid breathing to palpitations and flushing, these are common symptoms of an emotional response. Other symptoms like headaches and chest pain may also arise. Stress-related chest pain can be serious because strong emotions like anxiety can trigger a heart attack in people with pre-existing heart disease.
Most people are concerned that chest pain may be serious, like a heart attack, when it does occur. However, there are many causes of chest pain and not all are serious. Anxiety-related chest pain is not an uncommon symptom. Similar to ‘butterflies in the stomach’ or stomach pain that we have all experienced when anxious, chest pain may also arise with anxiety without there being any serious disease or disorder.
Why does chest pain occur with anxiety?
The chest pain that most of us may experience with anxiety usually has nothing to do with the heart. It may be psychogenic pain. This means that it is pain that we perceive yet it does not arise from any physical problem. However, the pain can be severe and cause significant concern. It is not uncommon for people to mistaken anxiety-induced chest pain for a heart attack. In some cases, a heart attack may even be triggered by anxiety.
It is important to understand the effects of anxiety which also applies to other forms of psychological stress and strong emotions. Depending on the trigger, the body’s flight or fight response is activated. Stress hormones are released into the bloodstream and the sympathetic nervous system is activated to allow a person to act to any imminent danger. This also increases heart rate and breathing.
As mentioned, pain is often psychogenic in nature during anxiety attacks. However, the effects of stress can lead to strain on the heart. This can cause cardiac pain in coronary artery disease which is known as angina pectoris. It may even lead to a heart attack. Stress can also increase the likelihood of acid reflux which may cause heartburn (burning chest pain). The raised breathing rate may also lead to chest pain if the lower airways and lungs are diseased.
Symptoms with Anxiety Chest Pain
Anxiety is a feeling of fear, apprehension or nervousness. It is not uncommon to experience anxiety at certain times in life, usually before an event or experience that can be stressful and have profound consequences. Usually the feeling is short-lived, lasting for a few minutes, hours or even days. However, some people have anxiety disorders where the anxiety is present without any trigger and can persist for prolonged periods.
Anxiety can also be a symptom of certain conditions. For example, a person experiencing a heart attack may report anxiety. Similarly, anxiety may be a symptom in conditions like hyperthyroidism where the thyroid gland is overactive. However, when anxiety occurs on its own it may present with a host of other signs and symptoms, such as:
- Stomach discomfort
- Agitation or restlessness
Pain is also a symptom that may arise or worsen with anxiety. Stomach pain is not uncommon with anxiety. Similarly chest pain may occur. These symptoms may not be a cause for concern and simply be the body’s physiologic response to stress. However, there are some warning signs and symptoms that require immediate medical attention.
Any episode of anxiety, chest pain or anxiety and chest pain with the following symptoms should be treated as a medical emergency.
- Severe chest pain.
- Excessive perspiration.
- Pain that radiates to the jaw or arm, particularly on the left side.
- Dizziness or fainting.
It is important to seek medical attention if the chest pain is persisting, worsening or present with the symptoms discussed above. Collectively these signs and symptoms are indicative of a heart attack. Emergency medical attention is required.
Read more on chest pain warning signs.
Other Causes of Chest Pain
Apart from psychogenic pain associated anxiety, these other causes of chest pain may also need to be excluded as a possible cause.
- Acid reflux
- Angina pectoris (heart)
- Heart attack
- Aortic dissection
- Respiratory infections (lower airways or lungs)
- Chest wall injuries (bruises, fractured ribs)
- Muscle strain
Read more on severe chest pain.
Tests for Chest Pain
Your doctor may conduct one or more of the following tests to confirm that the chest pain is not caused by any other disease or disorder, other than the anxiety.
- Chest x-ray to visualize the chest organs. A CT scan or MRI are other imaging techniques but are not usually conducted at the outset.
- Electrocardiogram (ECG/EKG) to monitor the electrical activity of the heart. A stress EKG may be preferable in some cases. Here a person has to undergo physical activity while the heart activity is monitored.
- Angiography or angiogram where the blood flow through the heart’s arteries (coronary arteries) are assessed for any narrowing or blockage.
- Upper gastrointestinal endoscopy to visualize the inside of the esophagus through a flexible tube with a camera at the end.
Remedies for Chest Pain with Anxiety
Anxiety chest pain is not serious but there are other causes of chest pain that may require medical care as soon as possible. If the pain is solely due to anxiety without any underlying diseases then conservative measures may be helpful. Anxiety disorders should be treated by a mental health professional. This may require a host of therapies including medication and counseling. Some of the following measures may be helpful
- Deep breathing can help you to calm down. Inhale deeply but slowly, hold your breath till the count of three and exhale slowly.
- Practice yoga or other stress management techniques if anxiety attacks occur often. These practices may help to prevent attacks or minimize the severity of an attack.
- Walk around slowly. Moderate physical activity can be helpful but should be avoided if a heart condition has not been excluded as a possible cause of the chest pain.
- Distract yourself by interacting with others or undertaking some other activity. This may help to ease anxiety-related symptoms like chest pain.