There are various causes of chest pain although most adults associate it with heart problems. Muscle strain, acid reflux, lung and airway diseases are some of the other common causes of chest pain. Certain emotional states can also trigger or worsen chest pain, particularly strong emotions. Most of the time it is thought that strong emotions strain the heart which can cause chest pain in a person with heart disease.
However, emotional stress can cause chest pain for other reasons even when there is no heart disease. This is probably most commonly seen with anxiety. Irrespective of the cause of anxiety, most of us have experienced some degree of chest pain or discomfort with it. Similarly we may experience discomfort in the abdomen which may be described as ‘butterflies in the stomach’ as discussed under a nervous stomach.
Anxiety-Induced Chest Pain
Anxiety is a common cause of chest pain and can occur for a variety of reasons. In a person with coronary artery disease for example, anxiety raises the heart rate which can lead to chest pain as the heart muscle is strained. Anxiety can also increase breathing rate and depth which may cause pain in a person with a lung disease. Severe chest pain must always be investigated, especially if there is shortness of breath, dizziness and other serious symptoms.
However, chest pain can also occur with anxiety even if there is no heart, lung or other physical disease. This type of chest pain is considered to be psychogenic. It can vary in intensity and may be severe to the point that it is debilitating. A person may even mistaken psychogenic pain for a heart attack and experience other heart attack symptoms.
Chest pain may be triggered, caused or worsened by anxiety. In these instances it is referred to ax anxiety-related chest pain or anxiety-induced chest pain if the pain is triggered or caused by an anxious state. Most of the time anxiety-related or induced chest pain is acute. It arises suddenly, lasts for a short period of time and often resolves without treatment.
Symptoms of Anxiety Chest Pain
Anxiety is the feeling of worry, apprehension or fear that occurs in every person at some point in life. It often arises in response to stress and is a temporary feeling until the stress is removed or a person adapts to the stressful situation. In anxiety disorders, the feeling occurs frequently, often unrelated to any stressful event, for a period of 6 months or more. Depression is a common mood disorder that is also present in most cases. Anxiety may also be related to substance abuse.
Some of the symptoms associated with anxiety apart from chest pain includes :
- Shortness of breath.
- Abdominal discomfort ranging from a stomach ache to abdominal pain.
Any other strong emotion like anger or psychological stress may cause these symptoms even if a person is not anxious.
Read more on stress chest pain.
Causes of Chest Pain with Anxiety
Anxiety causes a physiological response in the body. Stress hormones rise and activity of the autonomic nervous system increases as part of the fight or flight response. This can increase the heart rate and blood pressure, depth and rate of breathing, secretion of gastric acid and gastrointestinal motility, as well as other effects. These physiological responses may result in chest pain. Alternatively the pain may be psychogenic.
The chest wall muscles may be strained in various ways. It does not only involve strenuous physical activity. Even rapid breathing and hyperventilation may strain the respiratory and accessory respiratory muscles. The strain on these muscles may lead to chest wall pain which is commonly muscular in origin but can also arise from the bones, connective tissue, nerves and skin of the chest wall.
Acid reflux is where stomach acid enters the esophagus (food pipe). It irritates, injures and even damages the tissue lining the wall of the esophagus. Excessive stomach acid, increased stomach muscle activity and disruption of the lower esophageal sphincter (LES) may be seen in anxiety. This tends to cause a burning chest pain (heartburn).
Hyperacidity can occur with anxiety. It may irritate the stomach lining, especially in a person with gastritis, or further irritate a pre-existing peptic ulcer. This causes pain in the upper abdominal region but extend to the lower chest area, usually in the middle and left side.
Stomach and Intestinal Cramps
Anxiety may increase the activity of the smooth muscle in the wall of the stomach and intestines. This may lead to stomach or intestinal cramps. It is more likely to occur in a person with a history of bowel conditions like irritable bowel syndrome or inflammatory bowel disease.
Heart-related chest pain is usually of the greatest concern as it is often serious and can sometimes be fatal. There are two main types of cardiac chest pain that is a concern – angina pectoris and heart attack pain. Anxiety can trigger angina pectoris which is a temporary condition affecting the heart. Anxiety can contribute to a heart attack if the heart is weakened.
Both angina pectoris and most heart attacks are primarily due to narrowing of the coronary arteries (heart arteries) that carry blood to the heart muscle. Anxiety increases the heart rate but the narrowed arteries cannot carry enough blood to the heart muscle for this increased activity. The heart muscle is injured or even damaged by the insufficient oxygen supply.
Emergency medical attention is necessary when chest pain presents with other symptoms like shortness of breath, excessive sweating, pain radiating to the jaw or arm particularly on the left side, dizziness, confusion or loss of consciousness. People at high risk of a heart attack or with existing heart diseases need to be particularly cautious.
Read more on chest pain tests.
A host of lower airway and lung conditions can cause chest pain. These conditions may be triggered or worsened by anxiety and other strong emotions. Asthma for example can be triggered and worsened by anxiety. Chest pain is more likely to occur with severe cases of asthma where the respiratory muscles are strained.
Read more on lung chest pain.
This is a pain disorder associated with psychological factors. It can be acute or chronic. Psychogenic pain is diagnosed when other possible causes have been excluded and tends to be more common among people with anxiety, depression or other mental health disorders. It may be episodic whereby the chest pain increases with the onset of anxiety and eases thereafter.