Anxiety is a common cause of chest pain and is often not an indication of any serious pathology, like a heart attack. The pain may be psychogenic, where the person perceives the pain although it cannot be attributed to any pathology, or it may be related to muscle strain, hyperacidity, acid reflux, stomach cramps or intestinal cramps. A person who is at risk of coronary heart disease, however, may be experiencing pain due to angina or a myocardial infarction (heart attack) during periods of anxiety.
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 strong emotion, mental or emotional stress may cause these symptoms even if a person is not anxious.
Anxiety causes a physiological response in the body as a result of elevated hormone levels (catecholamines – fight or flight hormones) and activity of the autonomic nervous system. 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 can cause chest pain.
Causes of Chest Pain with Anxiety
Some of the causes of chest pain with anxiety may arise as a result of :
- Muscle Strain
- Rapid breathing and hyperventilation may strain the respiratory and accessory respiratory muscles.
- The strain on these muscles may lead to chest muscle pain.
- Acid reflux
- Rising gastric acid as a result of hyperacidity, 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).
- Gastritis and Peptic Ulcer
- Hyperacidity as a result on anxiety may irritate the stomach lining, especially in a person with gastritis, or further irritate a pre-existing peptic ulcer.
- This causes pain in 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 irritable bowel syndrome or inflammatory bowel disease.
- Urging to pass stool (tenesmus) may also be reported.
- Psychogenic 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.
- Neuropathic pain that may be seen in conditions like diabetic neuropathy may also need to be ruled out.
- Cardiac Pain
- In coronary heart disease, the increased activity of the heart in response to anxiety may strain the heart muscles as a result of restricted blood flow.
- This causes chest pain and it is important to distinguish between cardiac and non-cardiac chest pain.
- Cardiac chest pain should be treated as a medical emergency as it is difficult to differentiate between angina and heart attack pain. The latter can be fatal.
- Shortness of breath, nausea and dizziness should not be attributed to anxiety as it may be a result of compromised cardiac functioning.
- If the pain is radiating to the left arm, neck, jaw, abdomen or back and sweating is also present, then immediate medical attention must be sought.