Anxiety is an overwhelming worry or fear. Besides its mental and emotional effects, anxiety can also cause physical symptoms, including chest pain.

Anxiety causes about 30-40% of emergency department cases of low-risk chest pain. Of people with generalized anxiety disorder, about 50% experience chest discomfort or pain.

The relationship between anxiety and chest pain is a two-way street. Just as anxiety can cause chest pain, chest pain can cause someone to be anxious—especially if they have an anxiety disorder.

When you feel fear, including anxiety-induced fear, your body enters a natural fight-or-flight response. The threat could be real or imagined, physical or psychological. During fight or flight, the body releases hormones, including norepinephrine, serotonin, dopamine, and GABA.

This anxiety response can result in a range of cognitive, behavioral, and physical symptoms, including chest pain.

Some people with anxiety experience panic attacks, which are sudden episodes of intense fear. Panic attacks often cause symptoms like chest pain and shortness of breath. People commonly confuse panic attack symptoms for heart attacks.

If you’re trying to figure out whether your chest pain is being caused by anxiety, consider what other symptoms you are having. An overwhelming feeling of fear or worry is one sign that the pain could be from anxiety.

During a panic attack, you might also experience the following physical symptoms:

• Trembling or tingling in your body
• Quick heart rate
• Trouble breathing 
• Dizziness
• Sweating 
• Chills
• Stomach pain or nausea

Anxiety and a heart attack may share similar symptoms. Like anxiety, a heart attack can also cause chest pain, heaviness, or discomfort. You might feel this in the center or left side of the chest. With a heart attack, pain may also occur in one or both arms, your back, shoulders, neck, jaw, or above your belly button.

If your symptoms improve after focusing on calming thoughts and doing deep breathing exercises, it could be anxiety.

You can also consider what you were doing leading up to the pain. If you were having anxious thoughts before the pain started, the pain may be from anxiety.

If you’re unsure of whether the chest pain is from anxiety or a heart attack, it’s best to get immediate help. Emergency medical providers can come to you to assess your symptoms and start doing tests on your way to the hospital.

Other Conditions That Can Cause Chest Pain

Anxiety and heart attacks aren’t the only cause of chest pain. Chest pain can be caused by a variety of things, including:

• Blockages or tearing in an artery (a blood vessel that carries blood from the heart to the tissues and organs)
• Lung infection
• Inflammation in tissues or cartilage, such as those that connect the ribs to the breastbone
• Gastrointestinal issues
• Pulled muscles, like from coughing or sneezing
• Pneumonia
• Shingles

If your chest pain is related to anxiety, it’s important to find ways to manage your anxiety to decrease your chest pain. You may want to try:

• Physical activity, such as practicing yoga or going for a walk
• Meditation, mindfulness, or relaxation techniques
• A well-balanced diet
• Reducing the amount of alcohol and caffeine you consume
• Proper sleep
• Stress reduction techniques like connecting with a loved one or journaling

Having a range of tools at your disposal is useful, as one habit alone might not always help reduce your anxiety or stress.

If these steps don’t work, or you feel you need more support, there are trained mental health providers who can help. Therapy and medications for anxiety can be effective in helping you manage your mental health. If you’re unsure where to start, reach out to your primary care provider for a referral.

If you know anxiety is causing your chest pain and you want help in managing your anxiety and its symptoms, contact a mental healthcare provider.

If you are unsure of whether your pain is from anxiety, call a healthcare provider. They may give you instructions on things to try at home or recommend you seek immediate help.

You should call for immediate help if:

• The chest pain is sudden
• The pain spreads to your jaw, left arm, or between your shoulder blades
• You have nausea, dizziness, sweating, a racing heart, or shortness of breath
• Any chest discomfort lasts longer than usual or quickly intensifies if you participate in lighter activity

Chest pain is a common but alarming symptom of anxiety.

Anxiety-related chest pain can sometimes be confused for a heart attack; if you’re not sure why you have chest pain, seek medical attention immediately.

Taking steps in your daily life to manage anxiety can help reduce chest pain and other anxiety symptoms.