Chest Pain Symptoms and Panic Disorder

What's the Difference Between Heart-Related Chest Pain and Panic Disorder?

anxious appearing man holding his chest in pain
What do you need to know about chest pain symptoms and panic disorder?. Istockphoto.com/Stock Photo©Daisy-Daisy

How Common is Chest Pain with Panic Disorder?

About 40 percent of people with panic disorder experience pain in their chest. Chest pain symptoms is listed in the Diagnostic and Statistical Manual of Mental disorders, DSM-5. under the symptoms associated with a panic attack. Whether or not you have panic disorder, pain in the chest area sounds an alarm. The first thought, and rightfully so, is that you are experiencing a possible heart attack or other cardiac event.

This possibility sends many people to the nearest emergency room for help. But, often chest pain symptoms associated with panic disorder are not related to the heart and are not, generally, considered serious.

Typical vs. Atypical Chest Pain

Professionals have divided chest pain under the headings of “typical” and “atypical.” Typical chest pain is thought to be more likely related to a cardiac event. Atypical chest pain, on the other hand, is thought to decrease the likelihood that the pain has cardiac origins. But, defining what is “typical” and what is “atypical” is not set by clear boundaries. And, although atypical chest pain reduces the likelihood of heart trouble, some people do, indeed, have atypical chest pain with a heart attack or other cardiac episode. This may be even more common in women, as heart disease in women often has different symptoms than heart disease in men.

The following provides a general overview of what is usually considered the characteristics of typical chest pain indicative of heart trouble and atypical chest pain often associated with panic disorder.

It is not intended to serve as a tool for self-diagnosis. All chest pain should be evaluated by a physician for proper diagnosis. Keep this in mind even if you've had panic disorder related chest pain in the past. People with panic disorder may have heart disease just as those who do not have panic disorder, and, as noted later on, may be even more likely to develop heart disease

Typical Chest Pain Associated With Heart Problems

"Typical" symptoms of heart related chest pain include:

  • Escalating chest pain reaching maximum severity after a few minutes
  • Constant pain, pressure or aching
  • Pain in the substernal area (beneath the breast bone) or left chest area
  • Pain that travels or radiates from the chest to other areas, such as one or both arms, the shoulders or the jaw
  • Pain that is brought on by exertion (although unstable angina may bring about pain without exertion)

Atypical Chest Pain Associated With Panic Disorder

"Atypical" chest pain may include:

  • Sharp or stabbing chest pain (note that sharp or stabbing chest pain can also be a symptoms of serious conditions such as pulmonary embolism)
  • Chest pain that is fleeting
  • Pain that is localized to a small area
  • Pain that occurs without exertion
  • Chest Pain that accompanies anxiety or a panic attack
  • Pain that is relieved or worsened when you change positions
  • Pain that can be reproduced or worsened by pressing over the area of pain

Mitral Valve Prolapse and Panic Disorder

Mitral valve prolapse (MVP) is a fairly common disorder, affecting approximately four to five percent of the general adult population. Basically, MVP involves an abnormal heart valve that “prolapses” or flops backward, allowing blood to leak back through the valve opening.

Many people with MVP have no symptoms. Some may have complaints of fatigue, heart palpitations, chest pain, anxiety and migraine headaches. For the majority of people, MVP causes no lasting negative effects and does not interfere with any life functions.

Research has shown some evidence of a correlation between MVP and panic disorder. Much of this research suggests that MVP occurs more frequently in those with panic disorder or other anxiety disorders. There is some controversy, however, as to whether or not this connection actually exists. Future studies will, hopefully, give us a more definitive answer.

A Word About Heart Disease and Panic Disorder

There have been several studies that have attempted to show a correlation between anxiety disorders and heart disease. A recent study by the Women’s Health Initiative of postmenopausal women suggested that those who reported a full-blown panic attack within six months of being interviewed, had a three-fold risk of having a heart attack, heart-related death or stroke over the next five years. This study also found that those who reported panic attacks were nearly twice as likely to die from any cause in the five years following the study.

But, this study, like others that have attempted to show a correlation between panic disorder and heart disease, has not provided the final answer. The participants of this study answered two screening questions about experiencing a "sudden attack of feeling frightened, anxious, or extremely uncomfortable" and "sudden episode of rapid or irregular heartbeats." This led to interviewers asking these participants questions about twelve panic attack symptoms within the past six months.

Some symptoms associated with panic attacks are very similar to cardiac problems, but are unrelated to heart function. The participants of this study who reported these "panic attack" symptoms within the past six months were not distinguished between a single panic attack, a few panic attacks or recurring panic attacks indicative of panic disorder. It is possible that some of those who answered positive to the screening questions about panic attacks may have actually been experiencing an undiagnosed heart problem.

It is difficult, at best, to prove a correlation between heart disease and panic attacks. Statistically, people with panic disorder have higher incidences of smoking, alcohol use, lack of exercise, obesity, high blood pressure and increased cholesterol. These are known risk factors for heart disease. Whether or not you have panic disorder, most professionals will agree: Reduce your known risk factors and reduce your risk of developing heart disease.

Bottom Line on Chest Pain in People with Panic Disorder

It's clear that panic disorder is associated with chest pain, but less clear whether those with panic disorder are more likely to suffer from heart disease. Symptoms of chest pain related to panic attacks versus that related to heart attacks can differ in general, but among individual people there is much overlap. At the same time, we know that seeking immediate medical care can make a difference for those who have cardiac related chest pain.

Until we know more, those living with panic disorder should seek medical attention immediately for chest pain. This may lead to unnecessary emergency room visits at times, but pales in comparison to the risk of missing heart attack related pain by dismissing it as a panic attack. Medical care for those with heart attacks has improved dramatically in recent years, but relies on people getting to that care in time. Whether you have panic disorder or not, check out these tips on how to survive a heart attack in those first hours.

Sources:

Foldes-Busque, G., Fleet, R., Denis, I. et al. Nonfearful Panic Attacks in Patients with Noncardiac Chest Pain. Psychosomatics. 2015. 56(5):513-20.

Foldes-Busque, G., Hamel, S., Belleville, G. et al. Factors Associated with Pain Level in Non-Cardiac Chest Pain Patients with Cormorbid Panic Disorder. BioPsychoSocial Medicine. 2016. 10:30.

Tully, P., Wittert, G., Turnbull, D. et al. Panic Disorder and Incident Coronary Heart Disease: A Systematic Review and Meta-Analysis Protocol. Systematic Reviews. 2015. 4:33.

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