In this Psycom article, Mindpath Health’s Zishan Khan, MD, discusses the difference between anxiety-related chest pains and heart attack chest pains, the symptoms of each, and when to seek medical help.

Can Anxiety Cause Chest Pain Zishan Khan, MD Mindpath Health

About 8 million people visit the emergency room in the United States each year with chest pain. But only about 800,000 people in the U.S. have a heart attack each year. What’s going on with the others?

Anxiety can be one cause of chest pain that’s just as frightening as a potential heart attack.

“Patients should always err on the side of caution when it comes to chest pain,” says Bruce Bassi, MD. “If they have any concerns of something sinister, then they should immediately go to the ER. Many patients with high anxiety have been to the ER for chest pain because it can be so scary, and very difficult to tell if it is cardiac in nature.”

Anxiety chest pains

Physical symptoms of anxiety can arise intensely or come about gradually, then peak in intensity and continue at a steady level or subside, says Monica Vermani, a clinical psychologist and the author of A Deeper Wellness: Conquering Stress, Mood, Anxiety and Traumas.

Symptoms of anxiety

  • Abdominal distress
  • A burning sensation inside the body or on the skin
  • A dull, persistent aching soreness
  • Diarrhea
  • Faster breathing
  • Headaches and muscle tension
  • Intense heart palpitations
  • Muscle twitching or spasms
  • Nausea and vomiting
  • Tightness in the chest
  • Tingling or numbness, commonly in hands and feet

Heart attack chest pains

According to the National Institutes of Health, nearly 20% of people—some 50 million—in the U.S. have an anxiety disorder. And the Centers for Disease Control and Prevention (CDC) reports that in the U.S. someone has a heart attack every 40 seconds, totaling about 805,000 people each year.

Zishan Khan, MD, a child, adolescent, and adult psychiatrist with Mindpath Health, a U.S. outpatient behavioral health services company, says there are major differences between anxiety chest pain and heart attack chest pain.

For a heart attack:

  • The quality of pain tends to be more of an intense pressure, almost like an elephant sitting on your chest, or someone grabbing your chest and squeezing very hard. It may also present with an aching or burning sensation, and some can even confuse it for heartburn.
  • Pain progressively worsens and does not improve with time.
  • Location of the pain starts in the chest, but radiates to the neck, jaw shoulder, one or both arms, upper back, or upper belly.
  • Sweating, nausea, and lightheadedness can accompany the chest pain, more so for women than for men.
  • Chest pain occurs during times of physical exertion and not necessarily during moments of stress.
  • The symptoms are longer-lasting and do not simply resolve; can lead to damaging effects that may be permanent.

While many of the symptoms of a heart attack resemble those seen in an anxiety attack (shortness of breath, sweating, nausea and vomiting, racing heartbeat, etc.), with a heart attack, there is typically no anxiety preceding your chest pain.

Causes of anxiety-related chest pain

Vermani says it is more typical for chest pain to present itself during a bout of anxiety or a panic attack.

“Often, people with anxiety hyperfocus on their physiological symptoms,” she says. “This results in an intensification of symptoms, as well as a pattern of catastrophizing through negative thoughts that create a state of fearfulness of losing control.”

It is important to understand that anxiety is about self-doubt. Anxiety involves both thoughts and physical symptoms, causing both to intensify and trigger emotional distress. Over time, anxiety sets in with a worsening intensity of symptoms.

Some causes of anxiety chest pain include

  • Stress, when left unattended, can be a major cause of anxiety chest pain for many people. The “fight or flight” response will soon kick in.
  • When you are anxious about something, whether real or imagined, it can be a trigger for anxiety chest pain.

Anxiety-related chest pain tends to result from situations where a person feels incredibly anxious, fearful, and vulnerable. A clear stressful trigger is usually identifiable.

Chest pain seen during a heart attack can result from physical activity and exertion, such as when lifting a heavy box or shoveling snow, in people with underlying cardiovascular disease.

How to relieve anxiety-related chest pains

  • Slowing your breathing can help slow down your thoughts as well. Try breathing in slowly to a count of five (you should be able to see your stomach rise or “swell” like a balloon) through the nose and exhaling slowly to a count of five through the mouth. Repeat this cycle several times until you get rid of all the unwanted feelings. Practice daily whenever you feel your anxiety rise.
  • Try relaxation techniques, including focusing on slowly tensing and then relaxing each muscle group. This can help you focus on the difference between muscle tension and relaxation. You can become more aware of physical sensations.
  • Call a trusted friend or, if you see a psychiatric clinician or therapist, call them.
  • Listen to calming music.
  • If you are prescribed medication for anxiety, do not skip any doses.

Lifestyle changes to prevent anxiety-induced chest pains

Simple changes in your lifestyle can go a long way in helping to prevent anxiety chest pains.

  • Practice regular breathing exercises daily.
  • It is very important to get regular exercise, especially cardiovascular and aerobic exercises, so that you can relieve tension, improve your mood, decrease stress levels, and boost your overall confidence to ward off anxiety.
  • Avoid caffeine, cigarette smoking, and excessive alcohol use, as these can worsen anxiety.
  • Stabilizing your blood sugar can also prevent anxiety attacks by avoiding spikes in your glucose levels. This is accomplished by eating regular and well-balanced, healthy meals.

When to see a doctor for chest pains

Bassi offers these tips for when you should see a doctor if you are experiencing chest pains:

  • If there was no anxiety preceding your chest pain
  • The pain came on suddenly with no explanation (such as overexertion)
  • You are experiencing real shortness of breath
  • The pain moves or is manifested outside of the chest
  • You nearly pass out or lose consciousness
  • You become confused or disoriented
  • The pain is accompanied by sweating, fast or irregular pulse, or nausea or vomiting

Want to learn more about your mental health? Visit our Patient Resources for articles, tips, and education from Mindpath Health’s expert clinicians.

Zishan Khan, MD

Frisco, TX

Dr. Zishan Khan is board-certified in child, adolescent, and adult psychiatry. Dr. Khan primarily treats children, adolescents, and young adults suffering from ADHD, anxiety, depression, and behavioral issues that cause hindrances. He works with patients of various cultural and professional backgrounds to help them improve their lives and conquer their struggles. Dr. Khan’s focus is to treat the whole person, ... Read Full Bio »

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