Can anxiety cause chest pain?

Chest pain is one of the most frightening symptoms anxiety can cause. When your chest feels tight or sore, it’s natural to think straight away of your heart, and that fear can make the pain worse.

Anxiety is a very common cause of chest pain. But chest pain can also be serious, so this post is honest about what you can and can’t tell at home.

If you have chest pain right now and you’re not sure what it is, call 911 (or your local emergency number). Don’t drive yourself. Emergency teams would much rather check you and find it’s anxiety than have you wait.

Can anxiety cause chest pain?

Yes. Chest pain and tightness are among the most common symptoms of anxiety and panic attacks. They’re so common that in one study at a Canadian heart hospital, about 1 in 4 people who came to the emergency room with chest pain met the criteria for panic disorder. Almost none of them were told it might be panic.

That same study also found that many of the people with panic disorder had heart disease too. Anxiety and heart problems can happen together, which is exactly why chest pain should be checked.

Why anxiety causes chest pain

When you’re anxious, your fight-or-flight response gets your body ready for action. Several things can make your chest hurt:

• Tense chest muscles. Your muscles brace for danger, including the ones between your ribs. They can ache or feel sore to touch, sometimes for hours or days.
• Fast, shallow breathing. Breathing high in your chest overworks those muscles. Breathing faster than you need (overbreathing) can also make your chest feel tight and cause tingling and dizziness.
• A pounding heart. Adrenaline makes your heart beat harder and faster, and you feel every beat.
• Your stomach. Stress can bring on acid reflux and spasms in your food pipe, which can feel like chest pain.
• Focusing on it. Once you notice a chest sensation, worry makes you watch it closely, and that makes it feel bigger.

What anxiety chest pain tends to feel like

People describe anxiety chest pain in many ways:

• a sharp or stabbing pain, often in one spot
• a tight, heavy or squeezing feeling
• a dull ache that lingers after a panic attack
• pain that gets worse when you press on your chest or take a deep breath

It often comes with other anxiety symptoms, like a racing heart, shaking, sweating, tingling or a sense of dread, and it may ease as the anxiety settles.

Anxiety or a heart problem?

Here are some patterns doctors notice. They are tendencies, not a test. Plenty of heart attacks don’t follow the “typical” pattern.

	More typical of anxiety	More typical of a heart attack
When it starts	At rest, or during stress or worry	Often during exertion, but it can happen at rest
Where	Often one spot, or moves around	Centre of the chest, may spread to arms, back, neck, jaw or stomach
What it feels like	Sharp, stabbing, or tight	Pressure, squeezing, fullness or heaviness
How long	Usually peaks within about 10 minutes	Lasts more than a few minutes, or goes away and comes back
What else	Tingling, shaking, fear, fast breathing	Cold sweat, nausea, breathlessness, light-headedness

Why you can’t rely on this table: heart attacks can feel sharp, they can happen at rest, and they can come with fear and a racing heart, just like panic. Women, older adults and people with diabetes are more likely to have “atypical” symptoms, like breathlessness, nausea, back or jaw pain, or unusual tiredness, with little chest pain at all. And having anxiety doesn’t protect you from heart disease.

When to call 911

Call 911 (or your local emergency number) straight away if you have:

• chest pain, pressure or squeezing that lasts more than a few minutes, or goes away and comes back
• pain that spreads to your arms, back, neck, jaw or stomach
• chest pain with a cold sweat, nausea, breathlessness or light-headedness
• sudden, severe pain that feels like tearing, or spreads to your back
• chest pain with sudden breathlessness or coughing up blood
• fainting

If you’re advised to chew an aspirin while you wait, only do so if you’re not allergic and haven’t been told to avoid it.

See a doctor soon if you have chest pain that comes and goes, chest pain when you exert yourself that eases with rest, or if this is the first time you’ve had chest pain like this.

What a doctor might check

Doctors usually start with a heart tracing (ECG) and a blood test for troponin, a protein released when heart muscle is damaged. Depending on your age and risk, you might also have a chest X-ray, blood pressure checks, or later tests like an exercise test. Normal results can bring real peace of mind.

Chest pain has many other causes too, including strained muscles, inflamed rib cartilage (costochondritis), acid reflux and chest infections. A doctor can sort these out.

Once your heart has been checked

If a doctor has checked you and found that your chest pain is from anxiety, that’s good news, and it’s something you can work with.

• Learn your pattern. Notice what your anxiety chest pain usually feels like. If it ever feels different, stronger or comes with new symptoms, get checked again.
• Breathe low and slow. Let your belly rise instead of your chest, and make your out-breath longer than your in-breath.
• Relax your upper body. Drop your shoulders, roll them back, and gently stretch your chest by opening your arms wide.
• Use warmth. A warm shower or heat pack can ease sore chest muscles after a panic attack.
• Watch the checking. Checking your pulse again and again, or searching symptoms, can keep the fear going. Our post on health anxiety explains why.

When to get help for the anxiety

If chest pain keeps coming with anxiety or panic, the anxiety itself deserves treatment. Cognitive behavioural therapy (CBT) helps most people with panic disorder, and it can teach your brain to stop reading chest sensations as danger. Our guide to anxiety and panic attacks and post on heart rate during a panic attack are good next reads.

Frequently asked questions

How long does anxiety chest pain last?

Chest pain during a panic attack usually peaks within about 10 minutes and eases as the panic settles. But tense chest muscles can stay sore for hours, or even a day or two, after a bad attack. Pain that lasts more than a few minutes and you’re not sure about should be checked.

Where is anxiety chest pain located?

It can be anywhere in your chest. Many people feel it in one spot, often on the left side over the heart, which is especially frightening. Location alone can’t tell you whether it’s anxiety or your heart.

Can anxiety cause chest pain every day?

Yes, especially if you’re anxious most of the time and your chest muscles stay tense. But daily chest pain should be checked by a doctor, at least the first time, to rule out other causes like reflux, muscle problems or heart problems.

Should I go to the ER for anxiety chest pain?

If you’re not sure what’s causing it, yes. Nobody will think you’re wasting their time. If a doctor has already checked you, and the pain feels exactly like your usual anxiety, you can try slow breathing first. If anything feels different, get help.

How Breatheasy can help

Once a doctor has ruled out other causes, Breatheasy can help you ride out anxious chest pain. Tap “I’m feeling anxious” and Luma walks you through it: rate how strong it feels, breathe slowly as your phone pulses gently, ground yourself with 5-4-3-2-1, then see how far the anxiety came down. Breatheasy is a self-help tool. It can’t tell what’s causing chest pain, so if you’re ever unsure, call 911 first. Breatheasy is coming soon to iPhone and Android.

Sources

• Panic disorder in emergency department chest pain patients, Fleet and others, The American Journal of Medicine, 1996
• Chest pain, NHS
• Heart attack symptoms, NHS
• Warning signs of a heart attack, American Heart Association
• Heart attack symptoms in women, American Heart Association
• Costochondritis, NHS
• Panic disorder, NHS