Chest Pain Caused by Anxiety or Panic Attacks

Chest pain is always an alarming symptom, because most of us (appropriately) associate it with cardiac conditions, in particular, angina or myocardial infarction (heart attack). However, chest pain can also be caused by a number of conditions that have nothing to do with the heart. One of the more common non-cardiac problems that frequently produces chest pain is an anxiety attack.

What Are Anxiety Attacks?

Anxiety attacks, also called panic attacks, are episodes of intense fear and emotional distress that usually occur suddenly and without warning, and typically last from several minutes up to an hour. These attacks may have a discrete trigger, but they also can occur without any identifiable cause. Anxiety attacks are often recurrent and are very distressing to the people who experience them, as well as their loved ones.

People who have panic attacks typically spend a lot of time worrying about having more attacks and often make seemingly unreasonable lifestyle changes in an attempt to avoid circumstances that will trigger future attacks. They may avoid situations that, they feel, have precipitated previous episodes or environments where they would not be able to escape easily if another attack should occur.

These avoidance adaptations can become quite extensive to the point where a person who suffers from panic attacks can become nearly housebound or otherwise withdraws from normal life experiences. These individuals are said to suffer from agoraphobia.

In addition to an intense feeling of fright, anxiety attacks also commonly produce real physical symptoms. These often include:

• Severe dyspnea (shortness of breath)
• Abdominal cramping
• Diarrhea
• Muscular pain
• Palpitations
• Chest pain

Chest Pain and Anxiety Attacks

The chest pain experienced by people who are having panic attacks can be quite severe and frightening. The pain is often fleeting and sharp, and it can even be experienced as a “catch” that interrupts a breath.

It is most likely a form of chest wall pain caused by the muscle contractions that may occur with anxiety. In fact, because of these intense muscle contractions, the chest can remain sore for hours or days after a panic attack.

The severity of chest pain is often magnified by the intense fear associated with a panic attack.

Evaluating Chest Pain

The fact that the chest pain is caused by an anxiety attack, and not by angina, is usually not difficult for a doctor to determine. A careful medical history and a good physical examination usually tell the story.

The electrocardiograph in a person with panic attacks often shows tachycardia but does not usually show any of the changes typically seen in people with heart attacks or angina. However, if significant risk factors for cardiovascular disease are present, a noninvasive evaluation to rule out coronary artery disease (CAD) may sometimes be a good idea.

In fact, some studies have suggested that people with chronic anxiety disorders have an increased prevalence of CAD—that is, chronic anxiety may be a risk factor for CAD. So doctors should not be too quick to simply write the chest pain off as being “simply” due to anxiety. They should at least entertain the possibility that both disorders may be present and should do an appropriate evaluation.

Prognosis

From a cardiac standpoint, unless coincident heart disease is also present, the prognosis after having chest pain due to an anxiety attack is very good. However, all too often—especially in an emergency room setting where people who have chest pain due to anxiety attacks often wind up—doctors who rule out a cardiac emergency are likely to brush the patient off as having a minor problem of no significance, but panic attacks should not be brushed off.

Anxiety attacks are often extremely disruptive to a person’s life. And the people who suffer from these attacks should be regarded as having a medical problem that needs to be addressed seriously.

A Word From Verywell

Anxiety attacks are a common cause of chest pain that is not due to heart disease. While it is useful to know that your chest pain has not been caused by CAD, if you have been told you have anxiety attacks—or if you suspect it from your own symptoms—it is important for you to seek out competent medical care.