Anxiety Chest Pain: Why It Happens and How to Find Relief

Picture this: you're in a parking lot, your heart racing, your palms sweaty, and suddenly there's a sharp, stabbing sensation in your chest. Your mind immediately jumps to the worst-case scenario—is this a heart attack? But then you remember you're running late, you're stressed about a work deadline, and you've been feeling anxious all day. Could anxiety really cause chest pain that feels this intense?

The answer is yes—anxiety can absolutely cause chest pain, and it's more common than you might think. In fact, non-cardiac chest pain (NCCP), which includes anxiety-related chest pain, accounts for approximately half of all emergency room visits for chest discomfort. But understanding the difference between anxiety chest pain and something more serious can be challenging, especially when the symptoms feel so real and frightening.

“Panic attacks can feel so intense that many people end up in the emergency room thinking they're having a heart attack,” says Taylor Barragan, a licensed clinical social worker specializing in anxiety disorders. “The physical symptoms are very real, but they're caused by the body' stress response, not a cardiac event.”

Anxiety chest pain: How it feels

Non-cardiac chest pain (NCCP) accounts for approximately half of all emergency room visits for chest discomfort. When anxiety is the culprit, the chest pain often feels sharp or stabbing, typically located between the ribs. Unlike the heavy, squeezing pressure of a heart attack, anxiety-related chest pain tends to be more localized and may come and go.

Along with chest pain, anxiety attacks and panic attacks can cause a range of physical symptoms:

• Shortness of breath
• Fast breathing or hyperventilation
• Heart palpitations or a racing heart
• Sweating
• GI discomfort or nausea
• Dizziness or lightheadedness
• Difficulty focusing or feeling disconnected
• Tingling in hands or feet
• Shaking or trembling

Can anxiety cause chest pain? The stress-body connection

When you experience anxiety or stress, your body activates the fight-or-flight response, part of your autonomic nervous system (ANS). This system has two branches: the sympathetic nervous system (which revs you up) and the parasympathetic nervous system (which calms you down). During periods of anxiety, the sympathetic nervous system takes over, releasing stress hormones like adrenaline and cortisol.

This hormonal cascade causes several physiological changes that can lead to chest pain:

• Muscle tension: The intercostal muscles between your ribs can spasm or tighten, causing sharp, stabbing chest pain.
• Hyperventilation: Rapid, shallow breathing can cause chest tightness and discomfort, and may lead to muscle spasms.
• Increased heart rate: Your heart beats faster and harder, which can feel like palpitations or chest pressure.
• Heightened sensitivity: Stress can lower your pain threshold, making normal sensations feel more intense.

“When we're anxious, our bodies are essentially preparing for a threat that doesn't actually exist,” explains Barragan. “The physiological changes are real—your muscles are tensing, your breathing is changing, your heart rate is increasing. But these changes can also make you more sensitive to pain and more aware of sensations in your chest.”

Anxiety attack vs panic attack vs heart attack: Key differences

Understanding the differences between anxiety attacks, panic attacks, and heart attacks can help you determine when to seek emergency care versus when you might be experiencing anxiety-related symptoms.

Panic attacks come on suddenly, peak within minutes, and then gradually resolve. They can feel extremely intense and frightening, but they're not life-threatening. Symptoms typically include chest pain, shortness of breath, heart palpitations, sweating, trembling, and a sense of impending doom.

Anxiety attacks tend to build more slowly and are generally less intense than panic attacks. They may last longer and are often triggered by specific stressors or worries. The chest pain associated with anxiety attacks is usually less severe than panic attack chest pain.

Heart attacks are medical emergencies that require immediate treatment. The chest pain from a heart attack typically feels like heavy pressure, squeezing, or fullness in the center of the chest. It often radiates to the left arm, jaw, or back, and may be accompanied by shortness of breath, nausea, cold sweats, and lightheadedness. Heart attack pain usually doesn't change with position or breathing, and it may worsen with exertion.

Key differences to watch for:

• Heart attack: Heavy, squeezing pressure that may radiate; often triggered by exertion; doesn't change with position or breathing.
• Anxiety/panic: Sharp, stabbing pain that may ebb and flow; often changes with position or breathing; may be triggered by stress or worry.

Other causes: Can stress cause chest pain that isn't anxiety or a heart attack?

While anxiety is a common cause of chest pain, several other conditions can also cause chest discomfort. Understanding these possibilities can help you and your healthcare provider determine the right diagnosis.

Musculoskeletal causes: Muscle strain, especially from exercise or heavy lifting, can cause chest pain. Delayed onset muscle soreness (DOMS) can also cause chest wall pain that may be mistaken for something more serious.

Costochondritis: Inflammation of the cartilage connecting your ribs to your breastbone can cause sharp chest pain that worsens with movement or deep breathing. This condition is often mistaken for a heart attack but is usually harmless.

Lung conditions: Pneumonia, pleurisy (inflammation of the lining around the lungs), or asthma can cause chest pain, especially when breathing deeply or coughing.

Pulmonary embolism: A blood clot in the lungs is a medical emergency that can cause sudden chest pain, shortness of breath, and coughing up blood. This requires immediate medical attention.

Heartburn and acid reflux: Gastroesophageal reflux disease (GERD) can cause chest pain that feels similar to heart attack pain. The pain often worsens when lying down or after eating.

Heart conditions: While less common in younger, healthy individuals, several heart conditions can cause chest pain:

• Angina: Chest pain caused by reduced blood flow to the heart muscle, often triggered by exertion or stress.
• Pericarditis: Inflammation of the sac surrounding the heart, causing sharp chest pain that may worsen when lying down.
• Myocarditis: Inflammation of the heart muscle, which can cause chest pain, fatigue, and shortness of breath.
• Coronary artery disease (CAD): Narrowing of the arteries supplying the heart, which can cause chest pain during exertion.
• Aortic dissection: A rare but life-threatening condition where the inner layer of the aorta tears, causing severe, sudden chest pain.
• Stress cardiomyopathy (broken heart syndrome): Temporary heart muscle weakness triggered by extreme emotional or physical stress.

Diagnosis and treatment options: how clinicians evaluate chest pain

When you seek medical care for chest pain, healthcare providers follow guidelines from organizations like the American College of Cardiology (ACA) and the American Heart Association (AHA) to evaluate your symptoms. The first priority is always to rule out life-threatening conditions like heart attacks.

Your provider will likely:

• Take a detailed medical history, including when the pain started, what it feels like, and what makes it better or worse.
• Perform a physical examination, checking your heart rate, blood pressure, and listening to your heart and lungs.
• Order an electrocardiogram (ECG or EKG) to check your heart's electrical activity and rule out serious cardiac issues.
• May order blood tests, chest X-rays, or other imaging studies depending on your symptoms and risk factors.

“The good news is that once serious conditions are ruled out, we can focus on managing anxiety-related chest pain,” says Barragan. “This often involves a combination of therapy, stress management techniques, and sometimes medication if anxiety is significantly impacting your daily life.”

Working with a healthcare provider: Building a plan for anxiety and chest pain

If you're experiencing chest pain and suspect it might be related to anxiety, working with a healthcare provider is essential. They can help rule out serious conditions and develop a treatment plan tailored to your needs.

Many people find that telehealth appointments with Gen Med are a convenient way to discuss anxiety-related symptoms, including chest pain. During a virtual visit, your provider can:

• Evaluate your symptoms and medical history
• Help determine if your chest pain is anxiety-related
• Develop a treatment plan that may include therapy, medication, or lifestyle changes
• Provide referrals to specialists if needed
• Order tests or imaging studies if necessary

When to seek emergency care: If you experience any of the following symptoms, call 911 or go to the nearest emergency room immediately:

• Chest pain that feels like pressure, squeezing, or fullness
• Pain that radiates to your arm, jaw, neck, or back
• Shortness of breath
• Nausea, vomiting, or cold sweats
• Dizziness or lightheadedness
• Rapid or irregular heartbeat
• Severe anxiety or a sense of impending doom
• Symptoms that don't improve with rest or relaxation techniques

Keep in mind that males and females can experience different symptoms during a heart attack. Women are more likely to experience nausea, fatigue, and shortness of breath, while men are more likely to experience classic chest pressure. When in doubt, it's always better to seek emergency care.

How to relieve anxiety chest pain

If you've ruled out serious medical conditions and your chest pain is related to anxiety, there are several techniques you can use to find relief:

Box breathing technique: This simple breathing exercise can help calm your nervous system and reduce chest pain:

Other helpful techniques include:

• Progressive muscle relaxation: Tense and then relax each muscle group in your body, starting from your toes and working up to your head.
• Grounding techniques: Focus on your senses—name 5 things you can see, 4 things you can touch, 3 things you can hear, 2 things you can smell, and 1 thing you can taste.
• Gentle movement: Light stretching or walking can help release muscle tension in your chest and shoulders.
• Warm compress: Applying a warm compress to your chest can help relax tense muscles.
• Mindfulness meditation: Practicing mindfulness can help you observe your symptoms without judgment and reduce anxiety.

If anxiety-related chest pain is interfering with your daily life, consider working with a mental health professional. Cognitive-behavioral therapy (CBT) and other evidence-based treatments can help you manage anxiety and reduce the frequency and intensity of chest pain episodes.

Key takeaways

• Anxiety can cause chest pain that feels very real and frightening, but it's usually not life-threatening. The pain is often sharp and stabbing, located between the ribs, and may come and go.
• If you experience chest pain with symptoms like pressure, radiating pain, shortness of breath, nausea, or cold sweats, seek emergency care immediately to rule out a heart attack or other serious condition.
• Gen Med can help you evaluate anxiety-related chest pain through telehealth appointments, develop a treatment plan, and provide referrals to specialists if needed.

FAQ

What do anxiety chest pains feel like?

Anxiety chest pain typically feels sharp or stabbing, often located between the ribs. It may come and go, change with position or breathing, and is usually accompanied by other anxiety symptoms like rapid heartbeat, shortness of breath, or sweating. Unlike heart attack pain, which feels like heavy pressure or squeezing, anxiety chest pain is more localized and sharp.

Can stress cause chest pain or pressure?

Yes, stress can absolutely cause chest pain or pressure. When you're stressed or anxious, your body releases stress hormones that can cause muscle tension in your chest, rapid breathing, and increased heart rate—all of which can lead to chest discomfort. However, it's important to rule out serious conditions like heart attacks, especially if the pain is severe, radiates to other areas, or is accompanied by other concerning symptoms.

What is the 3-3-3 rule for anxiety?

The 3-3-3 rule is a grounding technique used to help manage anxiety in the moment. It involves: naming 3 things you can see, identifying 3 sounds you can hear, and moving 3 parts of your body (like your fingers, toes, or shoulders). This technique helps shift your focus away from anxious thoughts and back to the present moment, which can help reduce anxiety symptoms including chest pain.