Chest Pain with Stress – Causes, Dangers and Warning Signs

Chest pain is often a cause of concern for adults. With heart disease being one of the most common causes of death among adults, chest pain is often immediately associated with heart problems. However, heart conditions are not the only reason for chest pain. There are many other causes, most of which are not serious or life-threatening.

What is Stress-Induced Chest Pain?

Stress-induced chest pain is where there is discomfort or pain in the chest triggered by stress, either physical, mental or emotional stress. This can happen with heart disease but stress may also trigger chest pain for other reasons. However, when chest pain occurs with dizziness, difficulty breathing and/or confusion then it should be investigated immediately.

The term stress is often used loosely but it is a growing problem in modern societies. Psychological stress is a combination of mental and emotional stress that stems from a host of factors, such as interpersonal conflict and financial distress. It has a physiological effect throughout the body. The heart is therefore not the only organ that is affected.

Is stress chest pain serious?

When experiencing stress induced chest pain, the following should be considered as risk factors.

• Are you at risk of a heart attack due to age, obesity, family history, angina, hypertension, high blood cholesterol, diabetes, cigarette smoking or other risk factors?
• Is this your first episode of chest pain due to stress in the past 3 months or has it been occurring repeatedly and with increasing frequency?
• Are you experiencing any dizziness, difficulty breathing, blurred vision, sweating or arm pain?

If you are at risk of a heart attack, have experienced previous episodes of chest pain which is either stress induced or not, with other signs and symptoms associated with a heart attack, then immediate medical attention is required. It is important to bear in mind that a heart attack may occur although no apparent risk factors are evident and with no prior warning. A cardiovascular examination with chest pain tests like a stress ECG can help to diagnose underlying heart conditions.

How does stress affect the chest organs?

Stress causes a wide range of effects of the body, from stimulating the central nervous system to increasing the secretion of hormones like adrenaline and cortisol. While adrenaline is responsible for a short term effects, it is cortisol (the primary stress hormone) that lasts for long periods. Cortisol accounts for most of the dire medical implications associated with prolonged stress.

With regards to the chest, the stress response may initiate one or more of the following :

• Increased heart rate.
• Increase in blood pressure.
• Short, shallow breathing.
• Contraction of the chest muscles – tightening and protruding of the breast area with shrugging of the shoulders.
• Reduced blood flow to the organs of digestion.

Read more on cardiac and non-cardiac chest pain.

Causes of Stress Chest Pain

The chest cavity harbors several important organs of the body’s respiratory, cardiovascular and gastrointestinal symptoms. Apart from the network of nerves traversing and lining the chest wall, muscles, bones and even the skin can be responsible for pain felt in or on the chest. Stress usually does not cause the pain but instead triggers the pain or worsens existing pain.

Heart and Blood Vessels

• Angina pectoris is chest pain that arises with temporary reduction in the blood supply to the heart. It usually arises when the coronary arteries are narrowed. Heart tissue is injured.
• Heart attack or myocardial infarction is where a portion of the heart muscle tissue dies due to an interruption of the blood supply to the heart. Often a narrowed artery is blocked by a clot.
• Pulmonary embolism is where a blood clot blocks the vessel carrying blood to the lungs. This blood clot usually arises from the leg as is seen with deep vein thrombosis (DVT)
• Carditis is inflammation of the heart which may arise with injury or infections. It can affect any layer of the heart, from the endocarditis which is the inner lining of the heart to pericarditis which affects the outer layer surrounding the heart.
• Palpitations is a pounding sensation caused by a more pronounced heartbeat. It can arise with various heart diseases but may also occur when the heart beats faster and harder with stress.

Airways and Lungs

Various conditions of the lower airways and lungs can cause chest pain. Stress may worsen the pain, as a person may breathe faster or deeper during periods of stress.

• Asthma is narrowing of the lower airways which limits airflow and is often related to allergies. It can also be triggered by exercise or psychological stress.
• Bronchitis is inflammation of the bronchi which branch to each lung. This mainly occurs with an infection in acute bronchitis while chronic bronchitis is usually a consequence of long term cigarette smoking.
• Pneumonia is inflammation of the lung tissue which often arises with infections. It is a serious condition. Chest pain is common and stress may increase breathing rate which can worsen the pain.
• Pleuritis or pleurisy is inflammation of the lining around the lungs known as the pleura. It may occur with injury or infection. Rapid or deep breathing can also worsen pleurisy pain.

Gut Chest Pain

The esophagus is the part of the gut that runs through the chest. Therefore problems with the esophagus will cause chest pain.

• Acid reflux (gastroesophageal reflux disease or GERD) is a common cause of chest pain. It typically causes heartburn and can worsen with stress.
• Hiatal hernia is where a portion of the stomach slips through the diaphragm and into the stomach.
• Ulcers in esophagus and upper stomach can also cause chest pain. Ulcer pain can worsen with stress.

Chest Wall Pain

The wall of the chest is made up of skin, fat, connective tissue, muscles and bones. It protects the internal chest organs. Various conditions can affect the chest wall, including:

• Trauma
• Fractures (broken bones)
• Nerve compression (pinched nerve)
• Skin diseases
• Shingles

Psychogenic Chest Pain

It is not uncommon for a person to experience chest pain during periods of intense psychological stress, fear or anxiety. This occurs even without there being any abnormality of the organs in the chest. Often this anxiety chest pain is mistaken for a heart attack but psychogenic chest pain usually resolves once a person calms down.