Why Is Chest Pain Caused by Stress and Anxiety?

For this article I consulted with Robert M. Davidson, MD, a cardiologist with SignatureMD, www.signaturemd.com.

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 Dr. Davidson. 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.”