Anxiety can absolutely cause chest pain, and it's one of the most common — and most frightening — physical symptoms that people with anxiety disorders experience. While chest pain from anxiety may not be dangerous to your heart, it can feel remarkably similar to a heart attack, leading many people to seek emergency care only to discover their heart is perfectly healthy.
Understanding the connection between anxiety and chest pain can help you recognize when your symptoms are anxiety-related versus when they might require urgent medical attention.
Note: If you have sudden, crushing chest pain or pain with shortness of breath, fainting, or sweating — call 911 or go to the nearest ER immediately.
Key Takeaways
A large fraction of chest-pain visits to emergency departments, around 50%, are found to be non-cardiac. Anxiety is one of the several causes of chest pains among people with no heart problems.
The pain feels real because anxiety triggers genuine physical responses, including muscle tension, rapid breathing, and increased heart rate, which can create actual discomfort in your chest.
While anxiety chest pain may not be dangerous, you should always get unexplained chest pain evaluated by a doctor to rule out cardiac causes, especially if it's your first time experiencing it or if you have risk factors for heart disease.
What Is Anxiety Chest Pain?
Anxiety chest pain is a physical sensation of discomfort, tightness, pressure, or pain in the chest area that occurs as a direct result of anxiety, stress, or panic. This type of chest pain is considered a somatic symptom — a physical manifestation of psychological distress.
Unlike the steady, predictable pain of a heart attack, anxiety-related chest pain often comes and goes, may move around your chest, and typically correlates with feelings of worry, fear, or stress. Research shows that chest pain is a frequent symptom reported during panic attacks, occurring in roughly 20% to over 70% of panic episodes.
The pain can range from a dull ache to sharp, stabbing sensations. Some people describe it as:
A tight band around the chest
Sharp, shooting pains
A burning sensation
Muscle soreness or tenderness
Pressure or heaviness
How Common Is Chest Pain from Anxiety?
Anxiety-related chest pain is surprisingly prevalent, though exact statistics vary depending on the study and population examined.
Research indicates that among people who visit emergency departments for chest pain, up to 50% have no identifiable cardiac cause. Studies also suggest that panic disorder and anxiety disorders are frequently identified in these patients with non-cardiac chest pain.
Prevalence in different populations:
General anxiety sufferers: A small study revealed that around 48% of people with generalized anxiety disorder report experiencing chest pain at some point.
Panic attacks: Between 20%-70% of people experiencing panic attacks report chest pain as a symptom.
Emergency department visits: Anxiety and panic account for a significant portion of chest pain cases with no cardiac origin.
Young adults: Anxiety-related chest pain is particularly common in people under 40 who don't have cardiovascular risk factors.
Although unexplained chest pain often requires cardiac evaluation, when cardiac causes are ruled out, addressing anxiety often improves symptoms.
What Causes Anxiety to Trigger Chest Pain?
Anxiety produces chest pain through several interconnected physical mechanisms, all stemming from your body's natural stress response system.
The Fight-or-Flight Response
When you experience anxiety, your body activates its sympathetic nervous system — the same system responsible for the "fight-or-flight" response. This triggers a cascade of physical changes designed to help you respond to perceived threats.
Research shows that during anxiety or panic, your body releases stress hormones like adrenaline and cortisol, which cause immediate physiological changes, including increased heart rate, elevated blood pressure, and rapid breathing. These changes can create uncomfortable sensations in your chest that feel like pain or pressure.
Muscle Tension
One of the most common causes of anxiety chest pain is muscle tension. When you're anxious, the muscles in your chest wall, shoulders, and back often tighten involuntarily.
How muscle tension creates chest pain:
Intercostal muscles (between your ribs) contract and remain tense
Prolonged tension leads to muscle fatigue and soreness
Poor posture during anxious episodes compounds muscle strain
Tension can persist even after the anxiety episode ends
Studies have found that musculoskeletal causes, including muscle tension from anxiety and stress, are among the most common explanations for chest pain in patients without heart disease.
Hyperventilation
Anxiety frequently causes changes in breathing patterns, particularly hyperventilation — breathing too quickly or deeply. This disrupts the normal balance of oxygen and carbon dioxide in your blood.
When you hyperventilate, you exhale too much carbon dioxide, which causes blood vessels to constrict slightly. This can reduce blood flow and create sensations of chest tightness, lightheadedness, and tingling. Hyperventilation is commonly reported in panic disorder; research suggests that roughly half the people with panic disorder experience hyperventilation symptoms, which may contribute significantly to chest discomfort.
Increased Heart Awareness
Anxiety heightens your awareness of normal bodily sensations, including your heartbeat. What you might normally ignore, like your heart beating a bit faster after climbing stairs, suddenly feels alarming when you're anxious.
This heightened interoception (awareness of internal body sensations) can make normal heart rhythms feel like pounding, racing, or skipping. The more you focus on these sensations, the more anxiety they create, establishing a feedback loop that intensifies both the anxiety and the perceived chest discomfort.
Gastrointestinal Factors
Anxiety affects your digestive system, and problems in your esophagus or stomach can create sensations that feel like chest pain. The vagus nerve connects your brain, heart, and digestive system, creating complex interactions between anxiety and gastrointestinal symptoms.
GI-related chest pain from anxiety includes:
Acid reflux or heartburn triggered by stress
Esophageal spasms caused by anxiety
Stomach pain that radiates to the chest
Aerophagia (swallowing air when anxious), which causes bloating and chest pressure
Research suggests that gastroesophageal reflux disease (GERD) and anxiety disorders frequently co-occur, with each condition potentially worsening the other.
Anxiety Chest Pain vs. Heart Attack: Key Differences
Distinguishing between anxiety-related chest pain and cardiac chest pain is crucial but challenging, as the sensations can overlap significantly. However, several characteristics can help differentiate them.
Location and Quality of Pain
Anxiety chest pain typically:
Occurs on the left side or in a localized spot
Feels sharp, stabbing, or like a sudden catch
May move around or shift locations
Often involves muscle tenderness when pressing on the chest
Can feel like a tight band or pressure, but is usually not crushing
Heart attack pain typically:
Occurs in the center or left side of the chest
Feels like crushing, squeezing pressure, or heaviness
Remains constant and doesn't move around
Doesn't change with applied pressure on the chest
May radiate to the arm, jaw, neck, or back
Duration and Timing
Anxiety chest pain:
Often comes on suddenly during or after a stressful situation
May last from seconds to minutes, or wax and wane over hours
Frequently accompanies other anxiety symptoms
Tends to improve with relaxation or distraction
May occur repeatedly over days or weeks
Heart attack pain:
Usually builds gradually over several minutes
Typically lasts more than a few minutes (often 15-20 minutes or longer)
Doesn't typically improve with position changes or calming down
May come and go, but episodes last several minutes each time
Represents a single acute event (though angina can be recurrent)
Associated Symptoms
With anxiety chest pain, you might also experience:
Rapid heartbeat or palpitations
Shortness of breath or feeling like you can't get enough air
Dizziness or lightheadedness
Tingling in hands or feet
Feeling of unreality or detachment
Excessive worry about having a heart attack
Nausea without vomiting
Trembling or shaking
With a heart attack, you might also experience:
Shortness of breath even at rest
Cold sweats
Nausea or vomiting
Profound fatigue
Pain radiating to arm, jaw, or back
Sense of impending doom (though this can occur with panic attacks too)
Pallor (pale or gray skin)
Research published in the American Journal of Cardiology found that certain features are more predictive of cardiac causes, including age over 60, known heart disease, pain that radiates to both arms, and pain associated with exertion rather than stress or anxiety.
Response to Movement and Position
Anxiety chest pain:
May improve or worsen with certain positions
Often worsens with focused attention on it
Can be reproduced by pressing on tender chest wall muscles
May improve with deep breathing exercises once hyperventilation is controlled
Generally doesn't worsen with physical exertion (though anxiety about exertion might)
Heart attack pain:
Typically doesn't change significantly with position
Often worsens with physical activity
Cannot be reproduced by pressing on the chest
Doesn't improve with deep breathing
May occur during or after physical exertion
When to Seek Medical Attention
Chest pain caused by anxiety is usually not the same as a heart attack, but because symptoms overlap, all unexplained chest pain should be medically evaluated. Moreover, chronic, severe anxiety is also associated with higher cardiovascular risk, so it is important to seek treatment.
Seek Emergency Care Immediately If You Experience
Chest pain that's severe, crushing, or feels like pressure or squeezing
Pain that radiates to your arm, jaw, neck, or back
Chest pain accompanied by shortness of breath, cold sweats, nausea, or lightheadedness
Chest pain that lasts more than a few minutes or comes and goes
New chest pain if you're over 40 (men) or 50 (women)
Chest pain if you have risk factors: smoking, high blood pressure, high cholesterol, diabetes, or a family history of heart disease
Chest pain with a feeling that something is seriously wrong
According to the American Heart Association, it's always better to have chest pain evaluated and find out it's not cardiac-related than to ignore a potentially life-threatening heart attack.
Schedule a Non-Emergency Medical Appointment If
You've been diagnosed with anxiety, but experience new or different chest pain patterns
Chest pain is interfering with your daily activities
You're experiencing frequent episodes that cause significant worry
You need help managing your anxiety symptoms
Over-the-counter approaches aren't helping your anxiety or chest discomfort
When You've Already Ruled Out Heart Problems
If you've had a thorough cardiac evaluation and your doctor has confirmed your heart is healthy, recurring chest pain could most likely be related to anxiety, muscle tension, or gastrointestinal issues. In such cases, anxiety management may be suitable as an initial treatment approach.
How Blossom Health Can Help
If anxiety-related chest pain is affecting your quality of life, connecting with a mental health professional can provide the support and treatment you need to manage both the anxiety and its physical manifestations.
Blossom Health offers accessible, virtual psychiatric care to help you address anxiety disorders and their symptoms. Our board-certified psychiatric providers can evaluate your symptoms, provide an accurate diagnosis, create a comprehensive treatment plan, and prescribe medications if appropriate — all from the comfort of your home.
Getting started is simple: visit Blossom Health to check if we're available in your state, verify your insurance coverage, and schedule your first appointment. Most patients can be seen within days, and appointments are conducted via secure video call at times that work with your schedule.
Treatment for anxiety might include therapy approaches like Cognitive Behavioral Therapy (CBT), medication management with SSRIs or other appropriate medications, and ongoing support to help you develop effective coping strategies. Our providers work collaboratively with you to find the treatment approach that works best for your individual needs and preferences.
Don't let anxiety and chest pain control your life. Effective treatment is available, and feeling better is possible. Visit Blossom Health to take the first step toward managing your anxiety and reducing the physical symptoms that come with it.
Medical Disclaimer
This article is for educational purposes only and does not constitute medical advice. The information provided should not replace consultation with a qualified healthcare provider. Individual responses to medications can vary significantly, and what applies to one person may not be safe for another.
Always consult with your doctor or pharmacist before making any decisions about medication changes, discontinuation, or interactions with other substances. If you're experiencing concerning symptoms or side effects, please seek professional help from a healthcare provider. In case of a medical emergency, contact your local emergency services immediately or call 911. For mental health emergencies, contact the National Suicide Prevention Lifeline at 988.
Important: This information is not a substitute for professional medical advice. Never stop taking prescribed medication or make changes to your treatment plan without consulting your healthcare provider first. Your safety and well-being are the top priorities.
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