Anxiety Chest Pain: What It Feels Like

First, the safety rule

Chest pain can be a symptom of a heart attack and should be treated as heart-related until proven otherwise. Call triple zero (000) and ask for an ambulance if chest pain is severe, getting worse, or has lasted 10 minutes.¹

That applies even if you have anxiety, and even if it has turned out to be panic before. You can’t tell if someone is having a heart attack from their symptoms alone.¹

Can anxiety cause chest pain?

Yes. Anxiety and panic attacks are among the common causes of chest pain, along with reflux, muscle strains and chest infections.¹ Chest pain is one of the typical symptoms of a panic attack, and it is the reason many people having one fear they are having a heart attack.²

It is more common than most people expect:

• A review of the research found that as many as one in four people who go to an emergency department with chest pain have panic disorder.³
• In a study of 771 emergency patients whose chest pain had no physical explanation, 44 per cent had panic-like anxiety. Emergency doctors picked it up in only 7 per cent of those cases.⁴

Why anxiety causes chest pain

• Muscle tension. Under stress your muscles tighten, ready for fight or flight. That includes the muscles between your ribs and across your chest wall⁵
• Over-breathing. Fast, shallow breathing during panic brings a feeling of constriction in the chest⁶
• A pounding heart. Adrenaline makes your heart beat faster and harder, which you can feel in your chest⁵
• Heightened sensitivity. In people with chest pain that isn’t from the heart, anxiety and panic are common, and they shape how strongly the pain is felt. The food pipe can also become more sensitive, and reflux is the most common cause of this kind of chest pain⁷

What does anxiety chest pain feel like?

It varies. People describe a sharp or stabbing pain, a dull ache, tightness, or a burning feeling. It often comes with other signs of panic: a racing heart, breathlessness, sweating, trembling, dizziness and a sense of dread, building to a peak within about 10 minutes.²

Anxiety chest pain or heart attack?

Heart attack pain is classically a pressure, heaviness, tightness or squeezing in the centre of the chest. It may spread to the arms, shoulders, back, neck or jaw, and come with nausea, a cold sweat or shortness of breath. Symptoms usually last at least 10 minutes and don’t ease with rest.^1,8

But the two overlap, and heart attacks don’t always follow the textbook:

• Some people having a heart attack have mild chest pain, or none⁸
• Women are less likely than men to have chest pain. They may have pain in the back, neck, jaw or arms, shortness of breath, nausea or unusual tiredness⁸
• A panic attack can cause sweating, nausea and breathlessness too²

Research has found that chest pain is more likely to be panic-related in people who are younger, are female, report a high level of anxiety and have pain that isn’t typical of heart pain.³ These are averages across groups. They can’t rule out a heart problem in any one person, so the safe approach is to be checked.

After the all-clear

If tests show your heart is healthy, that is good news, and it is not the same as “nothing is wrong”. Chest pain that isn’t from the heart tends to keep coming back and leads to a lot of doctor visits and time off work, although it doesn’t shorten life.⁷

Treatment helps. A Cochrane review of 17 trials with about 1,000 people found that psychological therapy, mainly cognitive behavioural therapy, reduced reports of chest pain by about 30 per cent in the first three months, and the benefit continued for up to nine months.⁹

What to do when it happens

1. Check the safety rule. Severe, worsening or lasting 10 minutes means 000
2. Slow your breathing. In through your nose, and a longer breath out
3. Loosen your shoulders and unclench your jaw
4. Wait it out. Panic peaks within minutes and then fades²

See how to stop a panic attack and anxiety and shortness of breath.

When to see a doctor

• Any chest pain that hasn’t been checked. All chest pain should be assessed by a doctor¹
• Chest pain that comes on with exercise or effort and eases when you rest
• Chest pain that keeps returning after a normal heart check
• Panic attacks or anxiety that are affecting your life

References

1. healthdirect. Chest pain.
2. healthdirect. Panic attacks and panic disorder.
3. Huffman JC, Pollack MH. Predicting panic disorder among patients with chest pain: an analysis of the literature. Psychosomatics. 2003;44(3):222-36.
4. Foldes-Busque G, Marchand A, Chauny JM, et al. Unexplained chest pain in the ED: could it be panic?. Am J Emerg Med. 2011;29(7):743-51.
5. healthdirect. Stress.
6. Better Health Channel (Victorian Government). Panic attack.
7. Fass R, Achem SR. Noncardiac chest pain: epidemiology, natural course and pathogenesis. J Neurogastroenterol Motil. 2011;17(2):110-23.
8. healthdirect. Heart attack.
9. Kisely SR, Campbell LA, Yelland MJ, et al. Psychological interventions for symptomatic management of non-specific chest pain in patients with normal coronary anatomy. Cochrane Database Syst Rev. 2015;2015(6):CD004101.