Stress Chest Pain

Stress chest pain is among the more disturbing symptoms that one will experience in life. The first thought is that of a heart attack and in high risk patients, this should always be a consideration. However in many cases of chest pain which is triggered or exacerbated by stress, a host of other physiological processes could account for the pain apart from the heart. Some of these may be related to serious pathologies while others are episodic and not as clinically significant.

When experiencing stress induced chest pain, the following should be considered  :

• 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 recurring episodes of chest pain, either stress induced or not, and experiencing 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.

Chest Stress

Stress is a physiological process initiated by sudden or persistent exposure of physical, emotional or mental strain. In response to the stimuli, the body secretes two hormones – adrenalin and cortisol. While adrenalin is responsible for a short term effects, it is cortisol (the primary stress hormone) that lasts for long periods and accounts for most of the dire medical implications associated with prolonged stress.

In 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.

The stress response is a normal physiological response. However the inability of the body to cope and deal with the stress response is where it is considered to be medically significant. Nevertheless stress management, whether your body is coping or not, should always be a consideration as the long term impact will be detrimental to your health.

Causes of Stress Chest Pain

The chest cavity harbors a number of 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.

The following causes may be triggered or exacerbated by stress. The pain may be sudden or insidious (developing gradually until it is apparent). The severity of the chest pain may also vary from intense and severe pain to a dull ache.

Heart Chest Pain

• Angina pectoris.
• Myocardial infarction (heart attack).
• Palpitations may be mistaken for pain.

It is important to note that any pre-existing cardiac condition will be aggravated and possibly cause pain due to stress.

Lung Chest Pain

• Asthma.
• Pleurisy.
• Pneumonia.

Chest pain in asthma is not common but stress may cause an acute asthmatic attack.

Gastrointestinal Chest Pain

• GERD or heartburn.
• Causes of excessive belching.
• Hiatal hernia.
• Gastric ulcer.

The stress response slows down digestion and reduces blood flow to the gastrointestinal organs. This can trigger pain after eating.

Bone Chest Pain and Muscle Chest Pain

Most of the causes of bone chest pain and muscle chest pain are aggravated by movement and/or breathing. Rapid breathing due to stress may therefore aggravate the chest pain.

Nerve Chest Pain

• Nerve chest pain due to trauma may aggravate with rapid shallow breathing.
• Shingles pain (post-herpetic neuralgia) is known to exacerbate due to stress although this may be insidious.
• Psychogenic chest pain is almost always triggered or aggravated by stress, particularly mental and/or emotional stress.
• Pain due to a pinched nerve may at times aggravate due to stress, particularly physical strain.Emotional or mental stress may cause rapid breathing and muscular contractions that could aggravate the compression on the nerve.