Can anxiety cause chest pain?

Yes, anxiety can cause sharp, aching or tight chest pain by bracing the muscles between your ribs, pulling your breathing high into your chest, and releasing adrenaline. Because anxiety chest pain and heart pain can feel the same, call emergency services if you are unsure.

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What happens in your chest

Chest pain with anxiety is common, and people describe it as sharp or stabbing, a dull ache, a tight band, or pressure. The word anxiety comes from the Latin "ango", which means to constrict. In alert mode, the muscles of your chest wall, between your ribs and across your chest, brace and stay braced, and held tension makes them tight and sore.

Anxiety also moves your breathing higher into your chest and makes it faster, with more sighs. The small muscles between your ribs tire from the extra work, and over-breathing lowers carbon dioxide, which can make your chest feel tight and bring tingling in your hands or lips.

Adrenaline makes your heart beat faster and harder too, so you feel it pounding in your chest.

Why it feels like a heart attack

Anxiety chest pain and heart pain can feel the same, and nobody can reliably tell them apart by how the pain feels. That is why doctors use tests. A doctor checks your heart with an ECG, a quick, painless tracing of its electrical activity, and often a blood test. Being checked and sent home is a good result.

If a doctor checked this same pain and found your heart healthy, the pain coming back with anxiety is often the same thing. Get checked again if it changes, comes with exercise, lasts longer, or your health has changed since.

Fear of a heart attack releases more adrenaline, which tightens your chest further. Checking your pulse or pressing on your chest again and again keeps your attention locked on it, and that loop can keep the pain going.

Why it keeps coming back

After weeks of anxiety, your body can stop switching between rest mode and alert mode and stay in alert mode. Alert mode is built for running from a threat, so it keeps the muscles across your ribcage braced.

Because your body holds that state, chest tightness can show up on days you do not feel anxious.

Breathing lighter, slower and lower, out into the sides of your ribs instead of up into your chest, rests the muscles between your ribs and lets carbon dioxide come back up over a few minutes. This state is trainable with daily practice.

Try LSD Breathing

Use this for chest pain a doctor has already checked, or while you wait for help to arrive.
Sit or lie down, whichever is more comfortable, and place your hands on either side of your ribcage for light, slow and deep breathing.
Breathe in slowly through your nose and feel your ribs widen out to the sides, rather than rising up into your chest.
Let the exhale fall without forcing it as your ribs draw back in, with no need to hear your breathing, and let your belly soften 10% more.
Take 4 to 5 breaths this way, then breathe naturally and notice.

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When to check with a doctor

You had chest pain in the last 3 days that no doctor has checked (get seen today).
Your pain is new, different from usual, coming more often, getting stronger, or starts when you are resting (get seen today; call 911 if you have it now).
It comes on when you walk fast, climb stairs or exercise and eases when you rest (get seen the same day; call 911 if it does not ease within 5 minutes of rest).
You have heart disease, diabetes, high blood pressure or high cholesterol, you smoke, or heart disease runs in your family.
You are pregnant or had a baby in the last few months (get seen today).
You use cocaine, meth or other stimulants (get seen today).
It burns behind your breastbone after meals or when you lie down.
It hurts more when you breathe in or cough, or comes with a fever (get seen today; call 911 if you are also short of breath).

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Common questions

How do I know if chest pain is anxiety or my heart?

Only tests can tell: an ECG and often a blood test. If you have never had the pain checked, see a doctor today. If you are unsure right now, call 911 or your local emergency number.

How long can anxiety chest pain last?

A sharp anxiety pain often lasts a few seconds, and your chest muscles can feel sore after a panic attack. Pressure, squeezing, heaviness or pain that lasts more than a few minutes, or keeps coming back, needs emergency care, whatever you think the cause is.

Where is anxiety chest pain felt?

People often feel it in the middle or on the left side, and the tightness can sit anywhere across the front of the chest. Heart pain can show up in the same places, so where it hurts cannot rule out the heart.