That Chest Pain Might Be This, Not A Heart Attack

If you’ve ever felt your chest tighten in response to stressor, you’re not alone: Chest pain is the second most common reason for adults to present to the emergency department. But often, the pain is not related to heart problems. Anxiety contributes to up to 40 percent of the chest pain felt by emergency room patients, according to an observational study published in The American Journal of Cardiology (1).

Men may be particularly prone to feeling such tightness in the chest during a minor crisis. “Men tend to symptomize emotional distress through physical sensations, so instead of admitting that they are hurt or angry or struggling with working from home with their kids, they’ll say, ‘My head is killing me,’ or ‘I have tension in my shoulders,’” says Debra Kissen, Ph.D., chief executive officer of Light On Anxiety CBT Treatment Centers in Illinois and co-chair of the Anxiety and Depression Association of America’s public education committee. Or: “I have chest pain.”

That’s not to say all chest pain is in your head—or benign. “Heart disease is the number one killer of men and women in the United States. We don’t want to wrongly tell a patient that their chest pain is anxiety and miss the heart attack,” says Martha Gulati, M.D., cardiologist, and chair of the 2021 American College of Cardiology/American Heart Association Chest Pain Guidelines. Anxiety, she says, is a diagnosis of exclusion, meaning it’s determined to be the cause of chest pain when other probable medical explanations have been ruled out.

Here’s what else you need to know about anxiety-induced chest pain—and how to keep your body’s stress response under control.

What Is Anxiety?

Imagine you’re sitting in the back of an Uber as your driver creeps above 90 mph. The average person would feel uncomfortable. “Anxiety is the physiological state of the brain and body being on alert for potential danger,” says Kissen. The body’s sympathetic nervous system is triggered to prepare for physical activity. Known as the “fight or flight” response, it’s your body’s way of preparing to either book it or muscle up to fend off a real (or imagined) threat.

During the fight or flight response, your heart rate increases to send oxygenated blood to your major muscle groups, digestion is slowed to divert energy elsewhere (say, your legs, so you can run), and your sweat glands act up to help cool the body. Sometimes, you may notice that your hands feel cold and tingly. “It’s because we don’t need fine motor skills at that moment to navigate an immediate threat,” Kissen explains.

A little bit of anxiety can be a good thing since it prepares you for life’s uncertainties. But when your body’s natural alert system is prone to frequent false alarms, anxiety becomes less valuable and more disruptive. The resulting distress can interfere with your ability to function normally. An even bigger buzzkill? “It’s hard to enjoy your life during moments you spend worrying that you’re dying,” Kissen says.

Related: Is Low Testosterone Causing Your Anxiety?

How Can Anxiety Cause Chest Pain?

“Physiologically, we know that stress or fear can cause your heart to race and body to sweat,” Gulati says. “But the cause of chest pain in anxiety-provoking situations isn’t entirely clear.”

Here’s what we do know: In moments of extreme or even average stress, “the body tenses up to protect the heart and other vital organs like a shield,” which can feel uncomfortable, explains Kissen. An increase in heart rate may also lead to heavier breathing, which can contribute to chest tightness.

This kind of discomfort can induce fear that amplifies the body’s natural stress response in those who are prone to health anxiety. “You may think, ‘This is it, this is the sign I’m dying,’” Kissen says. And while she’s careful not to dismiss her clients’ physical symptoms, fear and anxiety over symptoms can contribute to the cycle of panic. “Fear creates more fear,” she says.

What Does Chest Pain From Anxiety Feel Like?

Although the experience is subjective, some men describe chest pain from anxiety as an elephant standing on their chest, Kissen says. If heavy breathing or hyperventilation accompany the chest tightness, it may also feel like you can’t get enough air.

How Common Is Chest Pain From Anxiety?

In a word: very. The average person feels some chest sensation when anxiety strikes, says Kissen. For some, this can be scary enough to warrant a hospital visit: Roughly 50 percent of people who show up in emergency rooms with chest pain unrelated to a cardiac event also have a diagnosed panic disorder while up to 33 percent have generalized anxiety, according to a 2022 Health and Quality of Life Outcomes study (2).

“People tell me, I’d hate to bother you if there’s ‘nothing’ going on, but you’re never bothering us,” Dr. Gulati says. “These are the types of things that are meant to be seen in the emergency room. This is why we’re here.”

How Long Does Anxiety-Related Chest Pain Last?

With the right response strategy (some ideas below), anxiety-related chest pain can vanish in a snap—but it passes more quickly when you can come to terms with it, Kissen says. “When you fight against your body to stop feeling what it’s feeling, you’re going to feel it more,” she warns. And like many physical symptoms that originate in our heads, “you can bring it on by trying to determine if it’s there,” she adds.

If the pain lingers after the stressful event has passed, be safe and head to the ER.