Causes of Chest Pain - Anxiety or Panic Attacks

anxiety attack
Anxiety Attack. Henrik Sorensen/Getty Images

Chest pain is a symptom that commonly accompanies anxiety attacks.

What Are Anxiety Attacks?

Anxiety attacks, also called panic attacks, are episodes of intense fear and anxiety that usually occur suddenly and without warning, and that typically last from several minutes up to an hour. These attacks may have a discrete trigger, but they also can occur without any identifiable cause.

Anxiety attacks are often recurrent, and are very impactful upon the person who experiences them.

People who have panic attacks typically spend a lot of time worrying about having more attacks, and often make seemingly unreasonable lifestyle changes in an attempt to avoid circumstances that will trigger future attacks. They may avoid situations that, they feel, have precipitated previous episodes, or environments where they would not be able to escape easily if another attack should occur. Agoraphobia is said to be present if these avoidance adaptations become extensive, to the point where the person with anxiety attacks becomes nearly housebound, or otherwise withdraws from normal life experiences.

In addition to an intense feeling of fright, anxiety attacks also commonly produce real physical symptoms. These often include severe dyspnea (shortness of breath), abdominal cramping, diarrhea, muscular pain, palpitations, and chest pain. During an anxiety attack, tachycardia (fast heart rate) and tachypnea (rapid breathing) also are often present.

Chest Pain With Anxiety Attacks

The chest pain experienced by people who are having panic attacks can be quite severe and frightening. The pain is often fleeting and sharp, or it can be experienced as a “catch” that interrupts a breath. It is most likely a form of chest wall pain, caused by the muscle contractions that may occur with anxiety.

In fact, because of these intense muscle contractions the chest can remain sore for hours or days after a panic attack.

The severity of the chest pain is often magnified by the intense fear associated with a panic attack. Not surprisingly, chest pain is the symptom that often sends people having panic attacks to the emergency room.

Evaluating the Chest Pain 

The fact that the chest pain is caused by an anxiety attack, and not by angina, is usually not difficult for a doctor to determine. A careful medical history and a good physical examination usually tells the story. 

However, if significant risk factors for cardiovascular disease are present, a noninvasive evaluation to rule out coronary artery disease (CAD) may sometimes be a good idea. 

What Is the Prognosis?

From a cardiac standpoint, unless coincident heart disease is also present, the prognosis after having chest pain due to an anxiety attack is very good.

However, all too often, especially in an emergency room setting (which is where people who have chest pain due to anxiety attacks often wind up), once the doctor rules out a cardiac emergency he or she is often likely to brush the patient off as having a minor problem of no significance.

But panic attacks should not be brushed off.

Anxiety attacks are often extremely disruptive to a person’s life, and the people who suffer from these attacks should be regarded as having a medical problem that needs to be addressed seriously. Treatment - with medication and with psychological counseling - is often quite effective in returning these people to more normal, happier lives. 

While it is useful to know that your chest pain has not been caused by CAD, if you have been told you have anxiety attacks - or if you suspect it from your own symptoms - it is important for you to seek out competent medical care. 


Fleet RP, Dupuis G, Marchand A, et al. Panic disorder, chest pain and coronary artery disease: literature review. Can J Cardiol 1994; 10:827.

Kroenke K, Spitzer RL, Williams JB, et al. Anxiety disorders in primary care: prevalence, impairment, comorbidity, and detection. Ann Intern Med 2007; 146:317.

Katon W, Vitaliano PP, Russo J, et al. Panic disorder. Spectrum of severity and somatization. J Nerv Ment Dis 1987; 175:12.

Continue Reading