Can anxiety cause chest pain?

Anxiety can cause chest pain in some cases. Specifically, panic attacks often result in feelings of chest pain, tightness, or pressure. In fact, somewhere between 22-70% of panic attacks include these physical symptoms. ^[1]

Panic attacks and persistent worry are hallmark symptoms of panic disorder (PD), a common type of mental health disorder affecting between 1 to 4 out of 100 people. ^[1] Somewhere between 18-25% of all patients who seek emergency medical care for chest pain have PD. ^[1]

Panic attacks can lead to chest pain in several ways. Hyperventilation, or episodes of rapid breathing, can cause the chest muscles to tense up. ^[3] Alternatively, overactivity of the nervous system can cause the small vessels of the heart to contract. ^[3]

Patients with panic disorder also tend to have a significantly higher rate of cardiovascular diseases, like cardiomyopathy and hypertension. ^[1]

Heart attacks vs panic attacks

There are some key differences between a heart attack and panic attack. During a heart attack, pain is often brought on after physical exertion and may radiate to other areas of the body, such as the arms, back, and shoulders. ^[2] Pain generally increases and reaches its peak after several minutes. ^[2]

On the other hand, a panic attack may cause sharp or stabbing chest pain that lasts just a few seconds and isn’t associated with strenuous physical activity. ^[2] It’s accompanied by feelings of anxiety or worry  and is usually localized to the chest. ^[2]

If you’re experiencing chest pain and unsure of the cause, it’s always important to seek medical help, in order to rule out other possibilities, such as cardiovascular disease.

Treatment options for chest pain from anxiety

Treating anxiety-related chest pain involves addressing the root cause rather than the symptoms. Treatment of panic disorder typically involves a combination of medication, psychotherapy, and lifestyle changes.

The most commonly used medications are antidepressants, especially selective serotonin reuptake inhibitors (SSRIs), and anti-anxiety medications, like benzodiazepines. ^[1] SSRIs are considered the first line of treatment since benzodiazepines have a high risk for tolerance and abuse. ^[3]

Cognitive-behavioral therapy (CBT) is the most commonly referenced therapeutic approach to treating PD. In some cases, it is considered as effective as medication. Also, psychotherapy interventions results are typically longer lasting. ^[1] CBT involves challenging one’s thoughts and behaviors in order to break maladaptive patterns.

Beneficial lifestyle changes include getting enough quality sleep, avoiding drugs and alcohol, eating a healthy diet, and getting adequate physical exercise. Mindfulness and deep breathing exercises can also be helpful in preventing or relieving panic attack symptoms and chest pain. ^[3]