Chest soreness from anxiety

Are They Linked?: Woodlands Heart and Vascular Institute: Cardiologists

Anxiety and Chest Pain: Are They Linked?: Woodlands Heart and Vascular Institute: Cardiologists

Chest pain is a frightening experience that sends many people to the emergency room. Nearly half of them learn they don’t have a heart problem. Of those, 30-40% discover that anxiety was the culprit.

In short, anxiety and chest pain share a close relationship, but that doesn’t mean you can assume anxiety is to blame. You can’t risk delaying medical attention when there’s a chance you have a heart condition or you’re having a heart attack.

If you suspect you’re having a heart attack, call 911. Otherwise, Laura Fernandes, MD, FACC, at Woodlands Heart and Vascular Institute can run diagnostics in the office to rapidly determine if you have cardiovascular disease.

Learn how anxiety causes chest pain and if it’s possible to tell the difference between anxiety and heart-related symptoms.

Anxiety defined

Anxiety is your body’s natural reaction to a threat, whether the threat is immediate or in the future. Any time you feel anxious, your brain automatically sends out hormones that activate the fight-or-flight response. 

Whether you’re stuck in traffic, worried about a job interview, or face a threatening situation, your brain’s natural reaction energizes your body so you can deal with the threat or quickly react and escape the situation.

How anxiety causes chest pain

When you’re anxious, your brain sends a surge of adrenaline and cortisol through your body. These hormones immediately trigger a rapid rise in your heart rate and blood pressure. As a result, many people experience chest pain and sweating, or have a hard time breathing.

The sudden boost of adrenaline can narrow the arteries in your heart and attach to cells inside the heart. This condition, called stress cardiomyopathy, mimics a heart attack, from symptoms all the way down to changes in your heart’s electrical activity.  

Though stress cardiomyopathy usually heals within a few days or weeks, it may lead to weak heart muscles, congestive heart failure, and abnormal heart rhythms.

Levels of adrenaline and cortisol don’t return to normal in people with anxiety disorders such as generalized anxiety disorder, panic disorder, and post-traumatic stress disorder. Chronically high hormone levels may trigger a panic attack (causing symptoms that feel like a heart attack) and increase your risk of cardiovascular disease.

Symptoms of anxiety vs. cardiac chest pain

It’s hard, if not impossible, to tell the difference between anxiety-induced chest pain and the pain caused by an underlying heart condition. In addition to your chest pain, both can cause:

  • Dizziness
  • Shortness of breath
  • Sweating
  • Heart palpitations
  • Feeling of dread or being out of control

Everyone experiences slightly different symptoms, whether they have anxiety or a heart problem. For this reason, the following two qualities aren’t written in stone. However, they’re generally true and may help you determine the cause of your chest pain:

Pain location

Chest pain from a heart attack often spreads throughout your chest and radiates to your jaw, shoulders, and arms. By comparison, chest pain from anxiety stays in your chest.

Pain patterns

Chest pain from a heart attack starts slowly and gradually gets worse, while an anxiety attack causes sudden chest pain that slowly improves. Many people find that anxiety-related chest pain goes away in about 10 minutes. However, other anxiety-related symptoms can last up to an hour after the pain improves.

If you have any questions about chest pain or other heart-related symptoms, call our office in The Woodlands, Texas,or schedule an appointment online today.

Is Atrial Fibrillation a Life-Threatening Condition?

Atrial fibrillation alone may not be life-threatening, but it seldom occurs alone, and it frequently causes deadly strokes. Here’s what you need to know about the dangerous complications of atrial fibrillation and the factors that increase your risk.

The Important Link Between Sleep Loss and Heart Disease

More than one-third of adults don’t get the sleep they need every night, putting all of them at a higher risk of developing heart disease. If you don’t get enough sleep, don’t wait to take steps to protect your heart.

Five Foods That Promote Positive Heart Health

Your diet has the power to prevent heart disease and relieve the stress on your heart after you’re diagnosed with a cardiovascular condition. We share five exceptional foods and how they can help promote a healthy heart.

What Can You Learn From an Echocardiogram?

If you have symptoms of a heart problem, chances are you’ll need an echocardiogram. Echocardiograms are safe and fast, quickly providing exceptional images used to diagnose heart problems and make treatment decisions.

Understanding Your Treatment Options for Atrial Fibrillation

Atrial fibrillation is the most common type of heart arrhythmia, but there’s good news: Getting treatment can restore normal heart rhythm for most people. Here’s a rundown of the treatments used to control atrial fibrillation.

5 Habits That Raise Your Risk of Varicose Veins

Everyone hates the appearance of varicose veins, but many don’t realize they can take steps to prevent them. You can lower your risk by learning about and changing the lifestyle habits that contribute to varicose veins.

What It Feels Like, Causes, and Remedies

Feeling worried, fearful, or nervous from time to time is quite normal for most people. These are typical reactions to atypical moments in everyday life.

Some people experience anxiety frequently. Symptoms can move beyond feelings of concern or worry to other physical reactions. Occasionally, these symptoms are mistakenly associated with other conditions.

As an example, chest pain is sometimes a symptom of anxiety. Often the result of a panic attack or heightened reaction, chest pain is a concern because of the possible connection to heart attacks and other heart conditions.

If you experience frequent anxiety, learning to understand your chest pain can help you find symptom relief and identify when you need additional medical help.

Anxiety symptoms are rarely the same from person to person. Some days, symptoms aren’t even the same for the same person. Anxiety presents itself in a variety of ways, and that makes detecting or understanding symptoms difficult.

Chest pain associated with anxiety feels different for each person. Some people may experience chest pain on a gradual basis. For others, the pain may be sudden and unexpected. Anxiety chest pain can be described as:

  • sharp, shooting pain
  • persistent chest aching
  • an unusual muscle twitch or spasm in your chest
  • burning, numbness, or a dull ache
  • stabbing pressure
  • chest tension or tightness

If you don’t have a history of chest pain with anxiety, you may be alarmed. Many people assume they’re having a heart attack and go to the hospital’s emergency department for treatment.

An estimated 25 to 50 percent of patients who come to the emergency department with low risk chest pain (chest pain not related to a heart attack) experience moderate to severe anxiety, according to 2018 research.

If you visit a hospital emergency room and the doctors don’t find a specific cause for your chest pain, consider consulting with your doctor about other possible causes, including anxiety.

Chest pain is a concerning symptom, and it’s usually best to seek emergency medical attention if you’re experiencing it. Even if the chest pain cause is anxiety, it’s better to know than to risk missing valuable time if you’re having a heart attack.

People describe chest pain in a number of ways when they’re having a heart attack. Some examples include:

  • chest pain that radiates to other parts of your body, such as down your arms or up to your jaw
  • chest pain that worsens with exertion
  • nausea along with chest pain
  • pressure in the chest, as if someone has put something heavy on your chest
  • rapid heart rate
  • shortness of breath
  • squeezing sensation in the chest

An estimated 30 percent of patients who are having a heart attack don’t have chest pain, according to 2020 research. Some people report symptoms like back pain and fatigue as part of their heart attack symptoms.

While doctors know there is a connection between anxiety and chest pain, you still shouldn’t ignore your symptoms and seek medical attention.

Call your local emergency services if you’re having chest pain. Don’t attempt to drive yourself to the hospital. Emergency personnel can evaluate you and determine whether you’re having a cardiac event or if there’s another reason for your chest pain.

When you’re anxious, your body can and often does produce physical reactions like sweating or shortness of breath.

When you become anxious, your brain and body set off an immediate stress response. This includes a physiological change. Your body may tighten up or grow tense.

A stress response can also include a psychological or emotional response. You may become aggressive or upset more easily. These responses are referred to as the fight-or-flight response. When you become stressed or anxious, your body prepares to fight back or run away.

If you experience this fight-or-flight stress reaction infrequently, your body should fully recover within 30 minutes. But if you experience it frequently, your body can’t recover as quickly. This can lead to increased muscle tension, and this tension may become painful in your chest.

Likewise, in an even more stressful moment, your heart rate may increase, and the force of your heartbeats can grow stronger. That combined with tight chest muscles can make you feel unusual pain.

If you feel anxious, there are some simple techniques you can try. These techniques may not work every time, but they’re a great starting point when you need help managing your anxiety.

Practice deep breathing

Focused, deep breaths can calm both your mind and your body. Find a quiet room or area, and inhale for a count of 10. Hold for a second, and then exhale for a count of 10. Repeat this several times as you feel your heart rate fall.

Take stock of the situation

Accept your feelings of anxiety, recognize them, and then work through putting them in perspective.

Are you worried about something you can’t control? Are you fearful of an outcome that’s unlikely? Are you dreading a situation you can’t control the outcome of? Talk your way through your feelings to find the source, and then work to put them into perspective.

Picture a beautiful scene

If you’re feeling anxious, try visualizing a place that instantly calms you. This can be especially helpful if you’re feeling anxious while in a situation you can’t avoid, like a stressful meeting. Practice deep breathing while you envision this location.

Use a relaxation app

Smartphone apps for anxiety can walk you through stress reduction techniques and exercises. There are also meditation apps that may help you quiet your mind when you’re feeling anxious. Many of these apps are free, so you can try out several to find one that works for you.

Be proactive about your physical health

Are you taking good care of your body? Are you getting enough sleep? Are you eating well? Taking good care of your body is also taking good care of your mind. While this won’t help treat anxiety chest pain, it may help you reduce your risk for anxiety and subsequent chest pain in the future.

If your anxiety and chest pain are severe or chronic, you may need to consult with a therapist. They can talk you through situations that cause anxiety and share coping techniques.

These techniques may not come naturally to you if you’re often anxious. This is where a healthcare professional can help.

A therapist or doctor may be able to teach you coping techniques that help you feel in control and secure. When you begin to regain a sense of calm, your symptoms, including chest pain, will subside.

If coaching techniques or mental exercises aren’t successful, you may need to consider a prescription. Anti-anxiety medications have side effects and risks. But using them as a stopgap while you learn how to cope with symptoms can be helpful.

Chest pain shouldn’t be ignored. If you’re experiencing it, seek medical attention to rule out a heart condition. If your chest pain is found to be related to anxiety, then you can work with a therapist or doctor to learn coping techniques or determine the best treatment for you.

Identifying anxiety as the cause of your chest pain is an important step in treating your condition. As you learn to manage the side effects of anxiety, you’ll also learn to manage unintended complications like chest pain.

While you can’t know for sure if or when you’ll experience anxiety chest pain again, preparing yourself with coping techniques and practices will help you feel more prepared and in control.

Read this article in Spanish.

causes of heaviness in the chest

Chest pain can be caused by various reasons: diseases of the cardiovascular, respiratory or endocrine system, diseases of the stomach, spine, intercostal neuralgia, panic attack, autonomic dysfunction. Some of them are unpleasant, but not dangerous, others are a threat to life. But if it hurts in the heart area and it's hard to breathe, you need medical help.


Chest pain and difficulty breathing may occur:

  • with myocardial ischemia - it can occur in a person who has not previously complained of diseases of the cardiovascular system after physical exertion, stress, if no help is given, a heart attack may develop;
  • in case of a heart attack - similar symptoms often appear in people suffering from heart disease, an urgent need to take the medicine recommended by the doctor;
  • with asthma - the main symptom that bothers the patient is suffocation, it seems that the chest is squeezing, an urgent need to take medicine to relieve asthma attacks; nine0012
  • with pulmonary embolism - the patient feels short of breath due to blockage of the trunk or branches of the pulmonary artery, the mucous membranes and skin become pale with a bluish tinge, an ambulance should be urgently called or the person taken to the hospital.

Myocardial ischemia

With a chronic lack of oxygen, the muscle tissue of the heart - the myocardium - is destroyed. Some people feel chest pain and complain that it is difficult to breathe. Others do not feel any unpleasant symptoms for a long time or feel rare pricks in the chest. But the disease is progressing. After physical exertion or stress, a sharp deterioration in the condition may occur: myocardial infarction, death. nine0003

Ischemic diseases are a common cause of sudden death. It is necessary to regularly visit a cardiologist for people who:

  • are overweight;
  • lead a sedentary lifestyle;
  • suffer from arterial hypertension, diabetes mellitus;
  • smoke, abuse alcohol.

If myocardial damage is diagnosed, medical or surgical treatment is prescribed: bypass surgery, coronary angioplasty. The patient should be observed by a cardiologist, follow a diet and a physical activity regimen recommended by the doctor, give up bad habits (you can use Nicorette tablets, sprays). nine0003

Heart attack

People suffering from myocardial ischemia may develop a heart attack, when the pain and heaviness in the chest becomes very strong, it is difficult to breathe. The condition is rapidly deteriorating. Up to 45% of people who have not received effective medical care die within 15 minutes.

The pathological process develops in four stages:

  • acute – acute pain appears, strong heartbeat, chills, pallor;
  • nine0011 necrosis - the muscle tissue of the heart dies;
  • subacute - the most dangerous stage, it is difficult for the patient to breathe, his temperature rises, he experiences severe fear, coordination of movements is disturbed;
  • scarring - the manifestations of dangerous symptoms are reduced, a scar is formed.

A heart attack may develop unexpectedly, but more often it is preceded by heaviness in the chest, shortness of breath, aching or stabbing pain. Even if the chest pricks no more than 1-2 times a month, you need to see a cardiologist, do an ECG. nine0003

Cardiac asthma

Cardiac asthma - asthma attacks that occur against the background of pathologies in the left side of the heart. It develops in patients suffering from heart defects, cardiosclerosis, ischemic disease, glomerulonephritis. With these diseases, blood circulation in the pulmonary circulation is disturbed. Pulmonary edema develops. X-rays of patients show that the volume of the heart is enlarged, and the tissues of the lungs contain fluid.

Seizures may begin for no apparent reason. The patient, waking up during day or night rest, feels pressure in the chest, he is seized with fear. But breathing problems can also arise due to stress, when playing sports, physical work, trying to catch up with outgoing vehicles. nine0003

How to relieve an attack?

A person should not be left alone during an attack of cardiac asthma. You need to calm him down, prevent panic, which will put an additional burden on the cardiovascular system. When there is pressure in the chest, it is difficult to breathe, you do not need to put a person to bed, on the contrary, air passes better into the lungs in a standing position. It is enough to support the patient, give him something to lean on, open a window, provide fresh air.

An attack may last a few minutes or 2-3 hours. With a prolonged lack of oxygen, the veins in the neck and arms swell, the skin acquires a gray tint, and pressure drops. The attack is stopped by taking Nitroglycerin or similar antianginal agents. The hospital uses oxygen concentrates, stationary devices for supplying oxygen to the lungs, respiratory analeptics. nine0003

Pulmonary embolism

Thromboembolism is the blockage of blood vessels by a thrombus, which causes life-threatening disorders in the cardiovascular and respiratory systems. The condition may worsen gradually or rapidly, when the symptoms of suffocation appear within 10-15 minutes after the onset of heaviness in the chest. Pulmonary embolism is the cause of 0. 1% of deaths.

Patients with a tendency to form blood clots are advised to use venotonics and be sure to see a doctor:

  • in violation of blood flow - with varicose veins or compression of blood vessels by tumors, in patients suffering from phlebothrombosis, when the valves of the veins are destroyed;
  • in case of blood clotting disorders - after injuries, operations, when drugs are prescribed to increase clotting, installation of intravascular catheters.


Taking good care of your health can help prevent life-threatening conditions. A doctor should be consulted at the first alarming symptoms, which may be mild: short-term sharp pain, periodic injections in the chest, on the left or in the middle, a feeling that occurs after stress or physical exertion that squeezed the chest. You should also consult a doctor if you need to be examined if it is difficult for you to breathe deeply. nine0003

If the condition worsens, these symptoms are accompanied by tinnitus, visual disturbances (double vision), discoloration of the skin and mucous membranes (pallor, gray or blue tint), fever, weakness, vomiting. Possible severe cough, sputum with blood. With these symptoms, you need to call an ambulance.

First aid

If a person has a stabbing in the region of the heart, squeezing the chest, you need to give him first aid. Such symptoms may indicate the development of deadly diseases in people who have not previously complained of pain in the heart. nine0003

You need to call an ambulance if:

  • a person has difficulty breathing, he cannot take a deep breath;
  • the temperature rises sharply above 38 degrees;
  • there is a sharp pain in the left or in the middle of the chest, which cannot be tolerated;
  • there is a strong cough, sputum, blood;
  • skin, mucous membranes turn pale, acquire a gray or blue tint;
  • sweating increases;
  • coordination of movements is disturbed, the patient complains of tinnitus, double vision, severe headache; nine0012
  • the person loses consciousness, speech becomes slurred or inadequate.

What to do before the ambulance arrives?

When there is pressure in the chest, there is a strong pain in the heart, breathing is disturbed, many feel great fear, turning into panic. Muscle tone increases, which makes breathing even more difficult. Do not leave the person himself, speak to him in a calm, confident voice, do not show your concern, keep him from sudden movements.

Provide free access to fresh air. If the room is stuffy, open the window. If the attack happened on the street on a hot sunny day - take him to the shade or to a cool room. nine0003

If breathing is difficult, chest tight, heart hurts - do not lay the person on his back or stomach. It is better to offer him a semi-sitting position, and for those suffering from cardiac asthma - vertical.

To relieve acute heart pain, you can put a Nitroglycerin tablet under the tongue. If diseases of the cardiovascular system were diagnosed earlier, you need to take the medicines prescribed by the doctor to relieve acute attacks.


A cardiologist cannot determine why the heart hurts based on the patient's complaints, examination, pressure measurement, pulse rate. Diseases have similar symptoms. Patients do not always accurately describe the nature and location of pain. In heart disease, it can be felt on the left or in the middle, in the back, in the left forearm or in the stomach. nine0003

ECG and ultrasound of the heart are done to make a diagnosis. After evaluating his condition, the functioning of the valves, noting malfunctions that provoke pain, the cardiologist can prescribe coronography, stress tests performed in a hospital.

Some diseases affect hematopoiesis and metabolism. They are identified and assessed by the degree of damage to the body on the basis of blood tests (general analysis, biochemical, determination of the level of platelets, sugar, cholesterol, lipoproteins) and urine. nine0003

Do not refuse the examination. Early detection of diseases of the cardiovascular system, when the symptoms are mild and do not bother the patient much, helps to prevent the progression of the disease, the development of complications and save lives. Follow the doctor's prescriptions, do not self-medicate, do not use traditional medicine without consulting a cardiologist.

Heart alarm - For a healthy lifestyle! - Articles - Center of Modern Cardiology

Very often people complain of pain in the heart, but it turns out that the stomach hurts, suffers from osteochondrosis or stress has led to the development of depression. And the development of a heart attack is not recognized, they are attributed to the same stomach, osteochondrosis or even toothache. How to figure it out? Let's try to help. nine0144

angina pectoris. That was the name in the old days of the disease that we now call angina pectoris. A heart attack usually begins with a pressing or burning pain in the center of the chest (doctors say "behind the sternum") during exercise or stress, although it can develop at rest.

The pain is quite intense, can radiate to the lower jaw, shoulders and arms (more often to the left, but possibly both), to the neck, throat and back. Sometimes it disguises itself as bursting pains in the same areas or pains in the stomach (upper abdomen - epigastrium), simulating an intestinal disorder. The pain disappears at rest in a few minutes, and if you put a nitroglycerin tablet under the tongue (or spray a spray containing nitroglycerin) - almost instantly. nine0003

If such pain lasts longer than 20-30 minutes and its intensity increases, the development of a heart attack is not excluded. Timely assistance significantly reduces the risk of dying from a heart attack, so you need to call an ambulance team as soon as possible. Recording an ECG in a heart attack almost always helps to make a diagnosis.

Heart attack cancelled. Very often, young women come to the doctor with complaints of pain in the heart. How could it be otherwise, because through the heart we pass all our troubles, worries and joys. In this case, there is usually no cause for alarm. nine0003

In young women, "pain in the heart" is often functional in nature, that is, they are not caused by angina pectoris. Female sex hormones protect blood vessels from the formation of atherosclerotic plaques. And if you look, “heart” pains bother women not in the area where “angina pectoris” likes to settle, but in the left half of the chest, in the armpit or under the left breast. They are, as a rule, in the nature of discomfort, stabbing or aching pain, and can last from half an hour to several hours or even days. nine0003

These feelings arise for various reasons. Stress, sleep deprivation, overwork, premenstrual periods…and, as a result, an anxiety or depressive disorder. The skeletal muscles are tense, on the shoulders they are compacted into painful lumps - “lumps of nerves”! Sometimes it is enough to have a short, but good rest, pleasant emotions.

In more serious cases, one has to seek help from a neurologist , a psychotherapist. Remember: the longer the depression lasts, the more difficult it is for the doctor to completely relieve you of discomfort, sleep disturbances and bad mood. However, in addition to stress, other reasons can lead to pain in the “heart area”. nine0003

"Bouquet of diseases". Osteochondrosis, a disease of sedentary people, leads to pinching of the nerve roots and the development of pain. If the thoracic spine is involved, then it is the heart that falls under the patient's suspicion - it pricks and pierces, lies on the chest with a lump or stone, catches with inhalations and sharp turns of the body, and aches for hours.

If such sensations occur during strong excitement, then the full impression of a heart attack can be formed. But the true cause of the pain in this case is the tension of the muscles of the neck and back. Unlike an attack of angina, which is quickly relieved by nitroglycerin, pain medications, massage, kneading the back with hydromassage jets can help, shock wave therapy. During examination, changes in the vertebrae can be found on an x-ray of the spine. But the ECG, even at the time of the most intense neuralgic pain, will be normal.

Chest pain may occur during a cold if it is complicated by bronchitis. Coughing can add discomfort, since already on the second day of a hacking cough, in addition to the bronchi, pectoral muscles will add to the pain. If the cold is complicated by pneumonia and pleurisy, then with a deep breath and exhalation, changes in pain can be noticed. The pain increases with inhalation, when the lungs straighten and “rub” against the inflamed pleura, and decreases with exhalation. nine0003

The doctor will recommend an x-ray of the lungs, listen with a phonendoscope for wheezing in the lungs.

Do not forget about the stomach, pancreas and gallbladder. A common cause of chest pain is intercostal neuralgia, herpes zoster, and in women - mastopathy. Regular palpations of the mammary glands must be carried out by women after 30-35 years, and if there is pain or induration, consult a doctor who will most likely refer you to an ultrasound of the mammary glands and mammography. nine0003

Gender matters, because it is in women that “heart pain” during examination turns out to be a mask of other diseases, and in men older than 40 any “gastritis, osteochondrosis attack or sore tooth” can turn out to be a first-time developed heart attack. A timely visit to the doctor is necessary if the heart is at risk.

On the other hand, all chest pains should not be blamed on a poor heart either.

Let's try to figure it out, analyze our feelings and try to distinguish between an attack that can threaten health and functional pain. nine0193 - Stitching or aching pain in the left side of the chest, which does not give anywhere?
- The pain begins and goes away gradually, lasts a long time, for hours, and even days, if you are stressed?
- Physical activity does not cause or increase discomfort in the heart area, and sometimes even relieves it?
- The pain does not go away after taking nitroglycerin, but subsides with sedatives?

If you answered “yes” to most of the questions, you probably don't have to worry about your heart.

Learn more