Can anxiety cause chest pain? Yes, how, and what to do

Have you ever felt an overwhelming sense of discomfort in your chest during an anxiety or panic attack? Have you asked yourself, “Can anxiety cause chest pain? The answer is yes. Chest pain is a common symptom of anxiety. 

In this article, we explain why people with anxiety have chest pain and what to do about it. Learn about symptoms of and treatment for anxiety, how to know when chest pain is considered an emergency, and when to seek help.

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Anxiety can cause chest pain

Many people who suffer with anxiety say that chest pain is their most concerning symptom during an anxiety attack. And worrying about chest pain as a sign of a heart problem can make anxiety worse. 

Chest pain can come from many sources. When it’s not heart-related, it’s considered non-cardiac chest pain (NCCP). Several conditions can cause NCCP, including depression, heartburn, anxiety, and other disorders. And conditions that lead to NCCP are estimated to make up 50% or more of emergency room visits for chest pain. 

How anxiety causes chest pain

When you’re anxious or stressed, your body prepares to fight or run away through a physiologic response called the fight-or-flight response. Usually, the body returns to normal within 30 minutes of the event that triggers the fight-or-flight response. 

But if you have frequent anxiety attacks, your body may not recover as quickly from anxiety’s hormonal and physical symptoms, such as a surge of stress hormones, increased heart rate, and a narrowing of blood vessels. The result is chest pain or NCCP that may feel like a heart attack or other condition, even though it’s not.

Several factors lead to chest pain from anxiety, including: 

• Hormone changes: stress hormones released in response to anxiety during the fight-or-flight response include cortisol and adrenaline. These hormones increase the heart rate and blood pressure, which can cause heart palpitations and spasms, resulting in chest pain. Adrenaline narrows the arteries that supply oxygen to the heart muscle. This temporary lack of oxygenated blood flow can mimic symptoms of a heart attack, including chest pain. 
• Muscles: becoming anxious triggers a stress response that leads to pain-inducing physical changes, such as tightening of the chest muscles.
• Hyperventilation (for example, rapid breathing): hyperventilation can occur during a stressful situation and fast breathing can make you feel short of breath. Hyperventilation can cause spasms of the coronary arteries (the major blood vessels that supply oxygen to the heart). Coronary artery spasms may reduce oxygen levels in the heart muscle, which results in chest pain.

Anxiety chest pain vs cardiac chest pain

Anxiety-related chest pain feels different for every person. For some people, it comes on gradually. For others, it may occur suddenly. 

Common symptoms of chest pain caused by anxiety can include: 

• A dull, aching sensation in the chest 
• Tightness or tension in the chest
• A sharp, shooting pain in the chest 
• A chest muscle spasm or odd twitch
• Chest pain that lasts just a few minutes or several hours
• A burning or stabbing sensation or numbness in the chest 

Common symptoms of chest pain from heart disease include:

• Sharp pain that worsens with exertion or increased activity 
• Uncomfortable squeezing, pressure
• Pain that spreads up to your neck, down your arm, or to your back or stomach
• Shortness of breath (with or without chest discomfort)
• Lightheadedness
• Nausea
• Breaking out in a cold sweat
• Sudden loss of consciousness 

When to seek immediate medical care for chest pain

Some symptoms of anxiety-related chest pain can mimic those caused by a heart problem. Always take chest pain seriously and:

• Seek immediate emergency medical care anytime you have intense, sudden, or new chest pain that lasts longer than 5 minutes.
• Contact your healthcare provider as soon as possible about any chest pain, even when it stops after a few minutes.

NCCP, such as the type of chest pain from anxiety, can happen repeatedly and negatively impact your quality of life. It’s important to consult with a mental or medical health professional to address the underlying anxiety causing your chest pain. 

Other causes of chest pain

Common non-anxiety causes of NCCP, include:

• Acid reflux (heartburn), which accounts for half of all instances of NCCP. A burning sensation in the chest just behind your breastbone is a symptom of heartburn and anxiety-related chest pain. Unlike anxiety-related chest pain, acid reflux symptoms are often relieved by taking antacids or repositioning your body (lying on your left side instead of your back). 
• Esophageal spasms are painful contractions in your esophagus. Unlike chest pain from anxiety, these spasms are commonly triggered by eating very cold or hot foods. Esophageal spasms can make you feel like something is stuck in your throat, where chest pain from anxiety doesn’t.
• Stomach conditions (such as achalasia) — some stomach disorders, such as achalasia, can cause food to back up into your esophagus and result in severe chest pain that can wake you up at night. Achalasia involves failure of normal relaxation of your lower esophagus muscles, which prevents foods from passing into your stomach. If you have severe chest pain along with the sensation of something being stuck in your throat, it may not be from anxiety. 
• Peptic ulcers can cause chest pain and a dull ache in the chest area. Unlike anxiety-linked chest pain, the gnawing or burning discomfort experienced from an ulcer often occurs around mealtime or at night and improves after you eat or take antacids.
• Chest infections or inflammation (such as pleurisy or pneumonia) can cause sharp, stabbing chest pain that worsens when sneezing, coughing, or breathing deeply. Pleurisy is inflammation of the membranes lining your chest which impairs normal lubrication and causes chest pain when breathing. Unlike chest discomfort caused by anxiety, this type of chest pain may be relieved by taking shallow breaths. 

How to relieve anxiety caused by chest pain

A range of anxiety treatments are available, depending on the type of anxiety, its severity, symptoms, and any co-occurring disorders. Anxiety treatment often includes medication or seeing a talk or behavioral therapist. Natural and self-help remedies are available for calming down anxiety too.

Self-help remedies for chest pain from anxiety

Non-medical self-help for anxiety that may work for you includes:

• Relaxation techniques: Deep breathing exercises and meditation are known to relax muscles and help alleviate anxiety. Studies show breathwork is linked with lower stress levels.
• Mindfulness practice: “Mindfulness-Based Stress Reduction (MBSR).” MBSR is an 8-week training program created by Jon Kabbot Zinn at the University of Massachusetts Medical Center in 1979. The program teaches how to focus on mind-body awareness to reduce the physiological effects of stress, pain, or illness. Studies show that MBSR demonstrated significant effects in reducing anxiety and depression symptoms, and the positive results continued for over 4 months after the initial training period. 
• Regular physical activity: Research shows aerobic exercise, such as dance classes, running, biking, or brisk walking, helps reduce chronic (long-term) anxiety by releasing endorphins. Endorphins are natural brain chemicals that can reduce stress and improve mood and well-being. Note: Speak with your healthcare provider before starting any new exercise routine.
• Dietary changes: Avoiding foods or drinks high in caffeine may help relieve anxiety.
• Herbal remedies: Some herbal preparations, such as adaptogens, are thought to help lower stress and anxiety. In clinical research studies, an adaptogen called “ashwagandha” reportedly lowered cortisol, a type of stress hormone).

Medical help for chest pain from anxiety

A common tailored approach to anxiety treatment is a combination of talk therapy to help with anxiety (psychotherapy) and medication.

One type of therapy proven to help anxiety is cognitive behavioral therapy (CBT). The foundation of this type of evidence-based therapy is that emotional distress results from negative thinking and dysfunctional behavior patterns. CBT helps you identify anxiety-inducing thoughts and devise ways to limit destructive thinking and self-defeating behaviors. 

Other types of therapy, such as exposure therapy or group therapy, may be recommended depending on your specific needs. In exposure therapy, your therapist will help you confront your fears and anxieties in a safe, supportive environment.

Anti-anxiety medication 

There are prescription anti-anxiety medications, such as Xanax (alprazolam) and Valium (diazepam). You can find resources on anxiety treatment, like how to locate a healthcare provider to prescribe Valium or how to get a Xanax prescription on Karity Health’s website. It’s important to talk to your healthcare provider about the addictive potential of some prescription anti-anxiety medications. 

Selective serotonin reuptake inhibitors (SSRIs), such as sertraline (Zoloft) and fluoxetine (Prozac), are non-addictive anxiety medications often prescribed for anxiety. These medications can be helpful for people with anxiety and depression. 

Learn more about Prozac for anxiety and Zoloft for anxiety.

Other symptoms of anxiety

Chest pain isn’t the only symptom of anxiety. There are several types of anxiety, including panic disorder, generalized anxiety disorder (GAD), and social anxiety disorder (SAD) each with different symptoms. Symptoms can vary depending on the individual too and may include: 

• Excessive, uncontrollable worry 
• Persistent fear or worry about day-to-day events
• Feeling on edge, irritable, or tense
• Restlessness
• Insomnia (trouble sleeping) 
• Difficulty concentrating or focusing
• Trouble making decisions
• General muscle tension
• Fast heart rate and increased blood pressure
• Upset stomach or nausea
• Urinating frequently
• Night sweats
• Trouble relaxing
• Extreme fatigue

Key takeaway

Important points to remember about anxiety and chest pain include:

• Chest pain is a common symptom of anxiety.
• Hormone changes, primarily cortisol and adrenaline, muscle changes, and hyperventilation are the primary causes of chest pain from anxiety.
• Chest pain from anxiety and heart problems is similar, but not identical. Cardiac chest pain often involves sharp pain, squeezing pressure, or pain that spreads up your neck or down your arm, while anxiety-related chest pain may be experienced as a dull ache, chest tightness, a chest muscle spasm, or a burning sensation in the chest.
• Anytime you have sudden, intense or new chest pain that lasts for more than 5 minutes, seek medical help.
• Treating anxiety can relieve chest pain caused by anxiety.

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Dealing with anxiety and chest pain can be overwhelming. But your symptoms don’t have to go untreated. Finding the right provider is key. And the Klarity Health platform makes it easy to find affordable, licensed mental health providers. Find an anxiety provider today. No insurance needed and no hidden fees.

Sources

American Heart Association, Heart Attack, Stroke, and Cardiac Arrest Symptoms, https://www.heart.org/en/about-us/heart-attack-and-stroke-symptoms

Cureus.com, Adaptogenic and anxiolytic effects of ashwagandha root extract in healthy adults: a double-blind, randomized, placebo-controlled clinical study, Salve J, et al, Dec. 2019, https://www.doi.org/10.7759/cureus.6466 

Frontiers in Psychology, Mindfulness and mental health in the time of the COVID-19 pandemic, Wendy Wen Li, W. et al, 2023, https://doi.org/10.1111/aphw.12441 

Nature, Effect of breathwork on stress and mental health: A meta-analysis of randomized controlled trials, Guy William Fincham, Clara Strauss, Jesus Montero-Marin, and Kate Cavanagh, 2023, https://www.nature.com/articles/s41598-022-27247-y

Johns Hopkins Medicine, What is generalized anxiety disorder?, https://www.hopkinsmedicine.org/health/conditions-and-diseases/generalized-anxiety-disorder 

Harvard Health, Calm Your Anxious Heart, 2023, https://www.health.harvard.edu/heart-health/calm-your-anxious-heart

Harvard Health, Can exercise help treat anxiety?, Ratey, J., Oct. 2019, https://www.health.harvard.edu/blog/can-exercise-help-treat-anxiety-2019102418096

The Primary Care Companion for CNS Disorder, Panic Disorder and Chest Pain: Mechanisms, Morbidity, and Management, Jeff C. Huffman, MD, Mark H. Pollack, MD, and Theodore A. Stern, MD, Apr. 2002, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC181226

*Appointments are generally available within 24 hours. Prescriptions, particularly for controlled substances, may require an in-person evaluation depending on the state of residence and current federal regulations.

The information provided in this article is for educational purposes only and should not be construed as medical advice. Controlled substances like Xanax or Valium may not be appropriate for all patients and any mention of these medications is for educational purposes only, not for marketing or encouraging self-diagnosis. Always seek the guidance of a qualified healthcare professional with any questions or concerns you have regarding your health. Providers on Klarity Health are independent practitioners with clinical autonomy. Nothing in this article is intended to diagnose or treat any condition, including guaranteeing prescription medication of any kind or dosage.  

If you’re having a mental health crisis or experiencing a psychiatric emergency, it’s crucial to seek immediate help from a mental healthcare professional, such as a psychiatrist, psychologist, or therapist. You can also call your local emergency services, visit your nearest emergency room, or contact a crisis hotline, such as the National Suicide Prevention Lifeline, by calling or texting 988 or dialing the Lifeline’s previous phone number, 1-800-273-TALK (1-800-273-8255) in the U.S.

How we reviewed this article: This article goes through rigorous fact-checking by a team of medical reviewers. Reviewers are trained medical professionals who ensure each article contains the most up-to-date information, and that medical details have been correctly interpreted by the author.