By Richard N. Fogoros, MD 

Updated on September 08, 2023

 Medically reviewed by Richard N. Fogoros, MD

 Fact checked by Nick Blackmer

Anxiety can cause physical symptoms like chest pain. 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.1 However, since chest pain can have serious causes, too, you should always check with your healthcare provider.

During an anxiety attack, your brain sends a rush of the stress hormones adrenaline (epinephrine) and cortisol through your body, causing your heart rate and blood pressure to rise. As a result, you may experience some physical symptoms like pain or tightness in your chest.2

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.

What Is Anxiety Chest Pain?

Chest pain is a common symptom of anxiety. 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.

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.

Where Does Anxiety Chest Pain Start?

Anxiety chest pain is often located in the center or left side of the chest. Unlike heart attack chest pain, which often starts in the chest then spreads into the shoulder and arm, anxiety chest pain usually stays in one place.

How Does Anxiety Cause Chest Pain?

During moments of stress, your body releases the hormones cortisol and adrenaline, which trigger the “fight or flight response.” The hormones are released in response to a threat, either real or perceived. The hormones 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.3

  • Adrenaline amplifies your energy output by expanding the airways, increasing your heart rate and blood pressure, and redistributing blood to muscles.2

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. On top of that, 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 chances; seek emergency care.

With that said, there are certain symptoms and factors that can help healthcare professionals differentiate an anxiety attack from a heart attack.4

Anxiety Attack

Pain usually 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 often radiate to the shoulder blades, arm, jaw, and/or neck.

Chest pain is more crushing or squeezing than 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.

Managing Anxiety Chest Pain

If your chest pain is caused by anxiety, you will need to manage your anxiety first in order to prevent chest pain. Strategies you can try to reduce your anxiety include:

  • Use relaxation techniques: Yoga, meditation, taking deep breaths, or counting to 10 or 20 slowly can help you relax when you feel anxious.

  • Eat healthy: A healthy, balanced diet goes a long way in improving health and wellness. Avoid skipping meals whenever possible.

  • Limit caffeine: Avoid energy drinks, coffee, chocolate, and other sources of caffeine.5

  • Exercise daily: Exercise programs are often recommended as part of an anxiety treatment plan, helping many people to “get out of their head,” by instead placing focus on the body.6

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:

  • Cognitive behavioral therapy (CBT)

  • Antidepressants

  • Anxiolytics (anti-anxiety drugs)

  • Benzodiazepines (a type of sedative)

  • Beta-blockers

 How Panic Disorder Is Treated

When to See a Healthcare Provider

If you’ve had one or more anxiety attacks, talk to a healthcare provider. If left untreated, chronic anxiety can undermine your emotional well-being and even increase your risk of chronic high blood pressure and heart disease.7

More often than not, chest pain is not caused by something life-threatening. However, since it may be a symptom of life-threatening events like a heart attack or collapsed lung, it’s important to see a healthcare provider right away if you experience it.

Call 911 or seek emergency medical care if your chest pain is severe or won’t go away, or if it is accompanied by shortness of breath, nausea, pain that radiates into your shoulders, or any other new or unusual symptoms.

 What Is Causing the Pain in Your Chest?

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 a sudden spike in blood pressure and heart rate.