Sudden chest pain is a common cause of emergency room visits. While it may be reasonable to assume that a heart attack is to blame, around 58% of cases have nothing at all to do with the heart but are rather due to an anxiety attack or panic attack.

During an anxiety attack, your brain sends a rush of the stress hormones adrenaline (epinephrine) and cortisol through your body, causing your heart rate and blood pressure to rise. As a result, you may experience some physical symptoms like pain or tightness in your chest.

This article describes the symptoms and causes of chest pain in people with anxiety or panic attacks. It also explains how healthcare providers are able to differentiate a heart attack from anxiety-related chest pain and what can be done to prevent future episodes.

What Is Chest Pain?

Chest pain, also called angina, is one of the most common reasons people see a healthcare provider. Chest pain can be chronic, occurring as a result of a long-term disease like arthritis, or it can be acute, due to a sudden event such as a chest injury.

According to the Wexner Medical Center, the most common causes of chest pain are:

  • Musculoskeletal conditions, such as a traumatic injury, arthritis, and fibromyalgia
  • Gastrointestinal conditions, such as acid reflux
  • Anxiety and panic attacks
  • Respiratory conditions, such as pneumonia
  • Heart-related conditions, such as a heart attack

Is Chest Pain a Symptom of Anxiety?

Chest pain is a common symptom of anxiety. The pain is often sharp, fleeting, or causes a sudden “catch” that interrupts a breath. The pain felt in the chest wall, caused by intense muscle strain or spasms, can sometimes last for hours or days after the attack.

Chest pain caused by an anxiety or panic attack is not “all in your head.” While it is true that anxiety can sometimes cause extreme somatic symptoms (such as sudden paralysis or blindness), symptoms like chest pain do, in fact, have physiological origins.

During moments of stress, your body releases the hormones cortisol and adrenaline that trigger the “fight or flight response.” The hormones are released in response to a threat, both real and perceived. Both have different effects on the body:

  • Cortisol rapidly increases blood glucose (sugar), providing you with a prolonged burst of energy to better cope with acute stresses.Adrenaline amplifies your energy output by expanding the airways, increasing your heart rate and blood pressure, and redistributing blood to muscles.

When these symptoms occur spontaneously as a result of an anxiety or panic attack, they can easily be mistaken for a heart attack. The sudden spike in heart rate and blood pressure alone can trigger chest pain.

Hyperventilation during panic attacks can also contribute by placing extreme stress on the intercostal muscles of the chest wall. On top of that, the fear you experience during an attack can further magnify the perception of pain.

Chest Pain From Anxiety Attack vs. Heart Attack

When an anxiety attack actually occurs, it can be difficult to think straight, much less determine whether your symptoms are heart-related. If in doubt, don’t take chance; seek emergency care.

With that said, there are certain symptoms and factors that differentiate an anxiety attack from a heart attack.

Treatments and Management of Chest Pain

If your chest pain is caused by anxiety, you will need to manage your anxiety first in order to prevent chest pain. Strategies you can try to manage your anxiety and help prevent panic attacks include:

  • Pain remains centered in the chest.

  • Chest pain is often described as sharp or stabbing.

  • There is often tingling or burning sensations in the hands and fingers.

  • Anxiety attacks can occur anytime and usually not during physical exertion.

  • Chest pain usually resolves within minutes or an hour.

  • Pain will radiate to the shoulder blades, arm, jaw, and/or neck.

  • Chest pain is more crushing or squeezing that stabbing.

  • There is often a tingling or burning in the shoulder and upper arm as well as heartburn-like aching or burning.

  • Heart attacks often occur after a physical strain or exertion.

  • Chest pain may come in waves but doesn’t go away.

  • Use relaxation techniques: Yoga, meditation, taking deep breaths, or counting to 10 or 20 slowly can help you relax when you feel anxious.Eat healthy: A healthy, balanced diet void of processed foods goes a long way in improving health and wellness. Avoid skipping meals whenever possible.Limit caffeine: Avoid energy drinks, coffee, chocolate and other stimulating sources of caffeine, which have been linked to stress and anxiety.Exercise daily: Exercise programs are often recommended as part of an anxiety treatment plan, helping many people to “get out of their head,” by instead placing focus on the body.

Treating chest pain from an anxiety attack may require the input of a psychologist or psychiatrist specially trained in anxiety disorders.

Depending on the severity and frequency of your symptoms, the treatment may involve one or more of the following:

  • Cognitive behavioral therapy (CBT)
  • Antidepressants
  • Anxiolytics (anti-anxiety drugs)
  • Benzodiazepines (a type of sedative)
  • Beta-blockers

When to See Your Healthcare Provider

If you’ve had one or more anxiety attacks, talk to a healthcare provider. If left untreated, chronic anxiety can undermine your emotional well-being and even increase your risk of chronic high blood pressure and heart disease.

More often than not, chest pain is not caused by something life-threatening. However, since it is a symptom of life-threatening events like a heart attack or collapsed lung, it’s important to see a healthcare provider right away if you experience it.

Summary

Anxiety attacks or panic attacks can cause chest pain that mimics a heart attack. It is caused by the release of the stress hormones cortisol and adrenaline during moments of acute anxiety or panic. The pain may come from contractions in the chest wall, muscle strain due to hyperventilation, or the sudden spike in blood pressure and heart rate.

Call 911 or seek emergency medical care if your chest pain is severe or won’t go away, or if it is accompanied by shortness of breath, nausea, pain that radiates into your shoulders, or any other new or unusual symptoms.

Frequently Asked Questions

  • How long does chest pain from anxiety last?
  • Anxiety-related chest pain usually lasts about 10 minutes, while other symptoms of a panic attack can linger for up to an hour. Pain related to a heart attack, however, will continue to come in waves.
  • Learn More:
  • Diagnosing a Heart Attack
  • What do I do for chest pain from a panic attack?
  • During an attack, it’s important to control your breathing. Inhale through your nose for three seconds, hold for two seconds, and exhale for three seconds. Remind yourself that this will pass and try to relax your body. If you are at risk of heart disease, go to the ER if the chest pain doesn’t go away within a few minutes.
  • Learn More:
  • 10 Breathing Exercises for Anxiety

Anxiety-related chest pain usually lasts about 10 minutes, while other symptoms of a panic attack can linger for up to an hour. Pain related to a heart attack, however, will continue to come in waves.

During an attack, it’s important to control your breathing. Inhale through your nose for three seconds, hold for two seconds, and exhale for three seconds. Remind yourself that this will pass and try to relax your body. If you are at risk of heart disease, go to the ER if the chest pain doesn’t go away within a few minutes.