Why chest pain with 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.

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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.

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.

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.

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.

In young women, "heart pain" is often functional, meaning it is 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.

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”.

"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.

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.

Gender matters, because it is in women that “heart pain” during examination turns out to be a mask of other diseases, and in men over 40 any “gastritis, osteochondrosis attack or sore tooth” may 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 the pains in the chest should not be blamed on the 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.
- 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. If so, complete the Hospital Anxiety and Depression Scale (HADS) and the CES-D questionnaire. Perhaps the stresses in your life have led to the development of depression and the consultation of a psychotherapist will relieve your "heart anxiety".

possible causes and when to sound the alarm

What should I do when I feel discomfort or pain in my chest? Perhaps it's a heart attack, or maybe another, less serious problem? In this article, we will look at the most common causes of pain in the chest cavity, as well as the typical signs of the diseases in which they appear.

The nature of the manifestation of pain is different: from sharp and piercing - to dull, but not strong. Sometimes it is described as squeezing or burning. In some cases, the pain radiates to the neck, then to the jaw, after which it moves to the back or down one or two arms.

The causes of chest pain can be varied, but the most dangerous of them are those related to the heart or lungs. Although in many cases the cause of pain has nothing to do with these organs.

Pain in the chest comes from:

  • The organs that are located in it are the heart, lungs and esophagus.
  • The components of the chest wall are skin, muscles and bones.
  • Organs located near the chest - liver, gallbladder, stomach, pancreas.

Sometimes chest pain is caused by pain in the neck that radiates to the chest. This is called referred or repercussion pain.

Causes related to the heart

  • Angina pectoris

All organs and tissues of our body need oxygen and nutrients that are carried in the blood. The heart pumps oxygenated blood through a huge network of arteries. This network includes vessels that supply blood to the heart muscle itself. These vessels are located on the surface of the heart and are called coronary arteries. They branch into smaller vessels located inside the heart muscle.

In people with coronary heart disease, the coronary arteries become clogged with fatty deposits called plaque. These deposits cause arteries to narrow and prevent oxygenated blood from reaching the heart. Angina pectoris is the term for chest pain caused by ischemia.

When the heart has to work harder, it needs more blood and oxygen. If additional oxygen-rich blood cannot pass through the narrowed coronary arteries, the heart begins to ache. That is why angina pectoris is especially manifested during physical activity.

Chest pain caused by angina pectoris manifests as discomfort or tightness behind the sternum during exertion. Sometimes it radiates to the arms, neck, jaw, or stomach area. As a rule, the pain of angina pectoris is mild and subsides after 10 minutes of rest.

  • Myocardial infarction (heart attack)

During a heart attack, the plaque is damaged or ruptured. Subsequently, the blood coagulation mechanism is triggered, during which a thrombus forms at the site of damage. The latter completely blocks the coronary artery or one of its small branches. This means that part of the heart muscle is left without blood and oxygen. If the artery is not quickly freed from blockage, the part of the heart muscle that remains without oxygen is damaged or dies. This is myocardial infarction.

The most common symptom of a heart attack is severe chest pain at rest. However, scientists from Harvard Medical School warn that pain is just one of the possible symptoms of an attack. Seek immediate medical attention if a person notices one or more of the following symptoms:

  • Compressive, burning pain in the center of the chest. Sometimes patients with a heart attack feel as if a belt is pulled tightly around their chest.
  • Pain, numbness, tingling or other discomfort in one or both arms, back, neck, jaw or stomach.
  • Shortness of breath or difficulty breathing.
  • Sudden nausea or vomiting.
  • Dizziness or lightheadedness.
  • Unusual tiredness and feeling of heaviness.
  • Heat or cold sweat.

Sometimes chest pain during a heart attack resembles angina pectoris, but in most cases it is more severe and prolonged.

Some heart problems that are not related to blood flow in the coronary arteries can also cause chest pain.

  • Variant angina

This type of angina occurs due to temporary spasm of the coronary arteries. Usually in this case, the arteries do not have constrictions or blockages.

  • Pericarditis

This inflammation of the pericardial sac (pericardium) causes severe pain that worsens when a person takes a deep breath or lies down.

  • Myocarditis

This is an inflammation of the heart muscle itself that causes chest pain. Myocarditis feels very similar to angina pectoris. Often inflammation of the myocardium is provoked by a viral infection.

  • Hypertrophic cardiomyopathy

In this condition, the heart muscle (myocardium) thickens, making it harder for the heart to pump blood. In a small number of patients, this disease manifests itself in the form of shortness of breath and chest pain. Sometimes the work of the electrical system of the heart is disrupted, resulting in an arrhythmia.

  • Aortic dissection

This rare but life-threatening condition affects the main artery that comes out of the heart, the aorta. This vessel consists of layers of muscle cells that can delaminate and rupture. Blood subsequently leaks to areas of the body outside the circulatory system. This is an extremely serious condition that requires the intervention of a vascular surgeon. With aortic dissection, the pain is very severe and appears suddenly, giving to the back or to the area between the shoulder blades.

Lung-related causes

A number of lung-related problems cause chest pain:

  • Pulmonary embolism
blocking the blood flow lungs. The pain comes on suddenly, is accompanied by shortness of breath, and may get worse when the person breathes deeply.

  • Pneumonia

Infection in the lungs causes not only cough and fever, but also chest pain.

  • Pleurisy

If the membrane that covers the lungs becomes inflamed, it causes pain. They are usually aggravated during inhalation and coughing. Pleurisy can occur due to a viral infection, as well as a complication of pneumonia, pulmonary embolism, or chest trauma.

  • Pneumothorax

With pneumothorax, air enters the space between the chest wall and the lung - the pleural cavity. Chest pain comes on suddenly and can last for hours.

  • Pulmonary hypertension

If pressure rises in the arteries that carry blood to the lungs, a person may experience chest pain.

Causes related to the digestive system

  • Heartburn (acid reflux)

This is a painful, burning sensation behind the breastbone that occurs when stomach acid enters.

  • Gallbladder or pancreas problems

Gallstones or inflammation of the pancreas cause abdominal pain that radiates to the chest.

  • Stomach or duodenal ulcer

An ulcer hurts in the upper abdomen, just below the breastbone. The pain characteristic of an ulcer comes and goes, and sometimes feels like chest pain. Accompanying symptoms of peptic ulcer disease are bloating, vomiting, feeling unwell, and a feeling of a full stomach after eating.

  • Esophagitis

Esophagitis is an inflammation of the esophagus that is sometimes caused by medication.

Other causes of chest pain include:

  • Panic attacks

panic attacks.

  • Shingles

This is an infection that affects the nerve and the area of ​​skin it innervates. If lichen affects the nerve that innervates the skin in the chest area, a person develops chest pain. In most cases, 2-3 days after the first pain sensations appear in the area of ​​nerve damage, a rash appears.

What should I do if my chest hurts?

Any new, severe or prolonged pain should be seen by a doctor as soon as possible. This is especially true for people who have previously experienced heart or lung disease. If you are worried about very severe chest pain that radiates to your arms or jaw, you feel unwell, you sweat a lot or are out of breath, call an ambulance immediately. These symptoms may indicate a heart attack.

If the pain is mild and infrequent, an examination is necessary. Its main goal is to exclude problems with the heart and lungs, which can pose a danger to human life. The main diagnostic procedures that are performed for chest pain:

  • electrocardiogram,
  • blood test,
  • chest x-ray,
  • endoscopy and other research methods.

If you are concerned about chest pain and want to find the source of it, see a physician.

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