Causes of Chest Pain - Anxiety or Panic Attacks

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Anxiety Attack. Henrik Sorensen/Getty Images

Chest pain is always an alarming symptom, because most of us (appropriately) associate it with cardiac conditions, in particular with angina or a myocardial infarction (heart attack). However, chest pain can also be caused by a number of non-cardiac problems. 

Anxiety attacks are one of the non-cardiac problems that often produce chest pain.

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 distressing to the people who experience them — as well as their loved ones. 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 and 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, and it can even 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. In fact, some studies have suggested that people with chronic anxiety disorders have an increased prevalence of CAD — that is, chronic anxiety may be a risk factor for CAD.

So doctors should not be too quick to simply write the chest pain off as being “simply” due to anxiety. They should at least entertain the possibility that both disorders may be present. and should do the appropriate evaluation.

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. 

Sources:

Angst J, Gamma A, Baldwin DS, et al. The Generalized Anxiety Spectrum: Prevalence, Onset, Course and Outcome. Eur Arch Psychiatry Clin Neurosci 2009; 259:37.

Fleet RP, Dupuis G, Marchand A, et al. Panic Disorder, Chest pain and Coronary Artery Disease: literature review. Can J Cardiol 1994; 10:827.

Tully PJ, Cosh SM, Baune BT. A Review of the Affects of Worry and Generalized Anxiety Disorder upon Cardiovascular Health and Coronary Heart Disease. Psychol Health Med 2013; 18:627.

Walters K, Rait G, Petersen I, et al. Panic Disorder and Risk of New Onset Coronary Heart Disease, Acute Myocardial Infarction, and Cardiac Mortality: Cohort Study Using the General Practice Research Database. Eur Heart J 2008; 29:2981.

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