Chest Pain Caused by Anxiety or Panic Attacks

Sudden chest pain is a common cause of emergency room visits. While it may be reasonable to assume that a heart attack is to blame, around 58% of cases have nothing at all to do with the heart but are rather due to an anxiety attack or panic attack.

Many people are surprised at how closely the symptoms of an anxiety attack mirror those of a heart attack. Moreover, studies suggest that anxiety attacks are more common than people realize.

According to a 2015 study published in Dialogues in Clinical Neuroscience, up to 33.7% of the population are affected by an anxiety disorder, including panic attacks, during their lifetime.

This article describes the symptoms and causes of chest pain in people with anxiety or panic attacks. It also explains how healthcare providers are able to differentiate a heart attack from anxiety-related chest pain and what can be done to prevent future episodes.

Verywell / Laura Porter

Chest Pain and Other Anxiety Attack Symptoms

Anxiety-related chest pain can be severe and frightening. The pain is often sharp, fleeting, or causes a sudden “catch” that interrupts a breath. The pain felt in the chest wall, caused by intense muscle strain or spasms, can sometimes last for hours or days after the attack.

The term "panic attack" is sometimes used synonymously with "anxiety attack," but they're not necessarily the same. Panic attacks can occur unexpectedly, abruptly, and with no known trigger. Anxiety is often triggered by emotional stresses and may build gradually. Anxiety attacks are less intense and often last longer.

A panic attack or anxiety attack can both cause physical and emotional symptoms. Some of the physical symptoms are physiological (meaning related to the body), while others may be somatic symptoms (mean physical manifestations of emotional distress).

Emotional
  • Apprehension or worry

  • Distress

  • A feeling of impending doom

  • Fear of dying

  • Fear of loss of control

  • Derealization (a feeling of detachment from the real world)

  • Depersonalization (a feeling of detachment from oneself)

Physical
  • Shortness of breath

  • Stomach cramps

  • Diarrhea

  • Muscle cramps or pain

  • Fast or irregular heartbeats

  • Rapid breathing

  • Cold sweat

  • Dry mouth

  • Dizziness or fainting

  • Chest pain

Causes of Chest Pain in Anxiety Attacks

Chest pain caused by an anxiety or panic attack is not "all in your head." While it is true that anxiety can sometimes cause extreme somatic symptoms (such as sudden paralysis or blindness), symptoms like chest pain do, in fact, have physiological origins.

During moments of stress, your body releases hormones called cortisol and adrenaline that trigger the "fight or flight response." The hormones are released in response to a threat, both real and perceived. Both have different effects on the body:

  • Cortisol rapidly increases blood glucose (sugar), providing you with a prolonged burst of energy to better cope with acute stresses.
  • Adrenaline amplifies your energy output by expanding the airways, increasing your heart rate and blood pressure, and redistributing blood to muscles.

When these symptoms occur spontaneously as a result of an anxiety or panic attack, they can easily be mistaken for a heart attack. The sudden spike in heart rate and blood pressure alone can trigger chest pain. Hyperventilation during panic attacks can also contribute by placing extreme stress on the intercostal muscles of the chest wall.

The fear you experience during an attack can further magnify the perception of pain.

Chest Pain From Anxiety Attack vs. Heart Attack

When an anxiety attack actually occurs, it can be difficult to think straight, much less determine whether your symptoms are heart-related. If in doubt, don't take chance; seek emergency care.

With that said, there are certain symptoms and factors that differentiate an anxiety attack from a heart attack.

Anxiety Attack
  • Pain remains centered in the chest.

  • Chest pain is often described as sharp or stabbing.

  • There is often tingling or burning sensations in the hands and fingers.

  • Anxiety attacks can occur anytime and usually not during physical exertion.

  • Chest pain usually resolves within minutes or an hour.

Heart Attack
  • Pain will radiate to the shoulder blades, arm, jaw, and/or neck.

  • Chest pain is more crushing or squeezing that stabbing.

  • There is often a tingling or burning in the shoulder and upper arm as well as heartburn-like aching or burning.

  • Heart attacks often occur after a physical strain or exertion.

  • Chest pain may come in waves but doesn't go away.

Evaluating Chest Pain

Healthcare providers can easily distinguish between chest pain from anxiety and from cardiac causes. It usually just takes a good medical history and physical exam.

They may also use an electrocardiogram (ECG), which shows how your heart is functioning. During a panic attack, it may show a fast or irregular rhythm. But it won't show changes typically seen in heart attacks or angina.

If you're at high risk for coronary artery disease (CAD), your doctor may want to do more tests to rule it out. Some studies suggest chronic anxiety disorders may be a risk factor for CAD.

Medical providers shouldn't be too quick to write the chest pain off as “just” anxiety. They should at least look at the possibility you could have both disorders and test you accordingly.

Treatment

Treating chest pain from an anxiety attack may require the input of a psychologist or psychiatrist specially trained in anxiety disorders.

Depending on the severity and frequency of your symptoms, the treatment may involve one or more of the following:

Summary

Anxiety attacks or panic attacks can cause chest pain that mimics a heart attack. It is caused by the release of the stress hormones cortisol and adrenaline during moments of acute anxiety or panic. The pain may come from contractions in the chest wall, muscle strain due to hyperventilation, or the sudden spike in blood pressure and heart rate.

Healthcare providers can distinguish between a heart attack and anxiety-related chest pain with an electrocardiogram (ECG) and other common heart tests and procedures.

A Word From Verywell

Anxiety isn't life-threatening like a heart attack. Still, it can have a significant impact on your quality of life.

If you've had one or more anxiety attacks, talk to a healthcare provider. If left untreated, chronic anxiety not only undermine with emotional well-being but also increases the risk of chronic high blood pressure and heart disease.

Frequently Asked Questions

  • How long does chest pain from anxiety last?

    Anxiety-related chest pain usually lasts about 10 minutes, while other symptoms of a panic attack can linger for up to an hour. Pain related to a heart attack, however, will continue to come in waves.

  • What do I do for chest pain from a panic attack?

    During an attack, it’s important to control your breathing. Inhale through your nose for three seconds, hold for two seconds, and exhale for three seconds. Remind yourself that this will pass and try to relax your body. If you are at risk of heart disease, go to the ER if the chest pain doesn’t go away within a few minutes. 

6 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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By Richard N. Fogoros, MD
Richard N. Fogoros, MD, is a retired professor of medicine and board-certified in internal medicine, clinical cardiology, and clinical electrophysiology.