Anxiety chest pain: is it just in your head?

Have you ever felt nervous or on edge? Many people know of the neurological aspects of anxiety where you feel anxious or irritable even though you aren’t in any real danger. There are also physical symptoms of anxiety in an anxiety attack, panic attack, or in people with generalized anxiety disorder. Common physical symptoms of anxiety include having a sense of impending doom or panic, sweating, heart palpitations, faster heart rate, trembling, shortness of breath, breathing very fast (hyperventilating), and feeling exhausted or weak (Chand, 2020). 

The coronavirus pandemic, lockdown, and economic repercussions of 2020 made many people feel anxious and scared. While it’s normal to feel anxious or worried some of the time in your everyday life, it’s not so normal to feel it all of the time (da Silva, 2020). 

One of the more alarming physical symptoms of anxiety can be chest pain. How can you tell the difference between anxiety chest pain and other serious heart conditions that may feel the same?

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The symptoms of anxiety present themselves differently, not just from one person to another but even in your own body. You might feel it in your stomach one day and your chest the next. This variation can make it a bit challenging to figure out what’s causing your physical symptoms (Campbell, 2017). 

Some people are prone to anxiety attacks or panic attacks, often leading to many physical manifestations of anxiety. With a panic attack, a person can have the sensation of choking, heart palpitations, sweating, shortness of breath, and chest pain. People with a generalized anxiety disorder may have those symptoms, as well as tremors, nausea, muscle tension, and dizziness (Bandelow, 2017).

Anxiety chest pain

If you’ve never had chest pain, you might feel frightened the first time you do! 

Anxiety chest pain doesn’t feel the same for everyone. Some people suddenly get chest pain even if they are at rest, common in a panic attack. Anxiety chest pain has a slower buildup, with most people already feeling anxious before the chest pain starts (Roller, 2020).

Anxiety chest pain symptoms in the chest area can feel like (Huffman, 2002):

• Stabbing, sharp, or shooting pain

• A constant dull ache

• Burning

• Tightness

• Spasms

• Numbness, where you can’t feel some parts of your chest

Other panic attack or anxiety attack symptoms include (Huffman, 2002):

• Shortness of breath

• Feeling dizzy or weak

• Shaky, trembling, or out of control

• Temperature changes—including feeling sweaty or cold

• Heart palpitations

• Chest pain

• Fast heart rate 

Chest pain from anxiety is more common in sudden panic attacks (Musey, 2018-a). 

The first time you feel any of these symptoms, you might go straight to the emergency room thinking you’re having a heart attack. Almost 80% of people in the emergency room with chest pain have non-cardiac chest pain and are not having a heart attack. Of this group, about 58% have moderate to severe anxiety (Musey, 2018-b; Musey, 2017). 

Heart attack chest pain

So what are heart attack symptoms?

A heart attack is when the blood flow or blood supply that feeds the heart itself is blocked. Heart attack symptoms include (Lu, 2015):

• Chest pain that continues to get worse with exertion

• Chest pain that radiates to your arms or jaw (this is called angina)

• Heavy pressure in the chest area and a squeezing sensation 

• Fast heart rate and shortness of breath

• Nausea

Some people feel exhausted or say they have back pain, and close to 30% of people having a heart attack don’t even report chest pain (DeVon, 2020).

Here’s a quick “cheat sheet” with the differences between anxiety chest pain and a heart attack. 

• When: Anxiety chest pain happens most often when at rest, and heart attack chest pain often happens during activity. Anxiety chest pain tends to start and end faster. Heart attack chest pain builds up and continues to increase in pain (Huffman, 2002). 

• Where: Anxiety chest pain usually stays in the chest, while heart attack chest pain can radiate through to the arms, shoulders, and jaw (Lu, 2015). 

• What: Anxiety chest pain often feels much sharper with reports of a stabbing-like pain, and heart attack chest pain usually feels more heavy, aching, and with squeezing pressure (Huffman, 2002).

• Who: Anxiety disorders, including panic attacks, are more common in women and heart attacks are more common in men (Bandelow, 2017; Kander, 2016).

Anxiety is a stress response, and your body reacts to stress in different ways. Some sensations are purely physical, like having shortness of breath, heart palpitations, sweating, or your body tensing up. 

You may have heard of the “fight-or-flight” stress response where your body gears up to fight back or run away from the stressor. If you have a lot of stress in your life, your body carries a lot more muscle tension. Some people experience this muscle tension in their chests. If you’re stressed out, this may raise your heart rate, and you can feel your heart pounding louder and stronger. These reactions together may make you experience anxiety chest pain (Huffman, 2002).

Other responses that can cause anxiety chest pain include breathing too rapidly and shallowly (hyperventilating).

Hyperventilating changes the level of carbon dioxide in the blood, causing dizziness, numbness and tingling in your extremities, and chest pain. Panic attacks can also increase the heart rate, which can cause coronary artery spasms, increased blood pressure (which strains the small blood vessels of the heart), and increased oxygen needs—all of which can cause chest pain (Huffman, 2002).

People with coronary artery disease or other heart problems may also suffer from anxiety. An anxiety attack or panic attack can exacerbate their heart issues (Greenslade, 2017).

Always seek medical care to get your chest pain checked out. Symptoms of anxiety/panic attacks and heart attacks overlap a bit. It’s best to have yourself evaluated in the emergency room under the guidance of an experienced healthcare professional.

If you are diagnosed with anxiety chest pain or non-cardiac chest pain, seek professional healthcare to manage your anxiety. Treatments can include cognitive behavioral therapy to manage your anxiety and, if needed, medications (Locke, 2015).  

Here are some steps to manage an anxiety attack or panic attack, even with chest pain (Locke, 2015):

• Breathe deeply, slowly, and steadily.

• Count to 10 and keep repeating until the feeling passes.

• Monitor your chest pain—anxiety chest pain doesn’t last long compared to a heart attack (Greenslade, 2017). 

• Focus on a calming favorite image while counting. 

Those are useful, though temporary, fixes. While you may not reduce anxiety completely, lifestyle changes can help you reduce the severity of your physical symptoms of anxiety. Try these strategies to manage your anxiety (Locke, 2015):

• Eat right—Increase your vegetables and decrease your sugar intake.

• Exercise—Aim for at least 150 minutes a week. Bodily movement helps reduce anxiety.

• Get enough sleep—Most people need at least 7 hours. 

• Avoid alcohol or tobacco.

• Decrease caffeine—Some people are sensitive to its effects.

Chest pain can be frightening. It is important to seek medical attention from a healthcare professional to evaluate if your chest pain is non-cardiac and anxiety-related or a symptom of a heart problem. Both conditions are treatable, so make sure you get the best treatment possible.

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Current version

April 12, 2021

Written by

Tobi Ash, MBA, RN, BSN

Fact checked by

Steve Silvestro, MD

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About the medical reviewer

Steve Silvestro, MD, Ro

Dr. Steve Silvestro is a board-certified pediatrician and Associate Director, Clinical Content & Education at Ro.