Do you keep suffering from chest pain and trying to convince yourself it’s from stress and anxiety rather than a looming heart attack?

Chest pain is frightening, because one of the causes is a heart attack or pending heart attack, yet a common cause of chest pain is also anxiety and stress, or panic attacks.

First of all, let’s be clear: This article is not about angina. Angina involves heart disease, and typically, stress and anxiety will cause or aggravate chest pain in a person who has angina.

But what about a person who does not have heart disease, or at least, has not been diagnosed with such?

Perhaps this individual’s calcium score is zero, which very likely means the absence of heart disease.

So what’s going on if they experience chest pain from anxiety or stress?

“Chest pains caused or aggrevated by stress should always be evaluated by a physician,” says Robert M. Davidson, MD, a cardiologist with SignatureMD.

This way, a pathological condition can be ruled out. In the healthy person, it is “generally not well-understood” just what the mechanism is behind chest pain resulting from anxiety or stress, says Dr. Davidson.

“Several possible and established mechanisms include coronary artery spasm (probably rare), esophageal spasm — more often associated with eating, or reflux; in some cases, due to an associated sudden increase in blood pressure, associated with stress; and sometimes in association with hyperventilation due to stress.

“If the pain is sharp (as opposed to heaviness or pressure), and/or is very brief (seconds or less), or is associated with tenderness in the area of pain, it is not likely to be heart related, and is probably not serious.”

Erratic, deep inhalations that occur in the midst of a heated, high charged argument can cause chest discomfort that’s related to forceful expansion of the ribcage from the combination of gulping in enough air to subsidize the exertion of high emotions, and the exertion of spewing out long strings of words in one breath to get your point across or dominate the other person’s speaking.

Dr. Davidson is with the Division of Cardiology at Cedars-Sinai Medical Center, Los Angeles, and has been practicing for 30+ years. Areas of specialty include coronary artery disease, heart attack and palpitations.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.