Anxiety and Chest Tightness: Why It Happens

What is fear?

Nearly one in five Americans has an anxiety disorder, and millions more experience anxiety that doesn’t reach the level of an actual mental health condition, according to the Anxiety and Depression Association of America. While anxiety can take many forms, one of the more troubling symptoms is a tightness in the chest, which can also be a sign of something more directly life-threatening, such as a heart attack.

It is always best to see a doctor or nurse to determine the cause of your symptoms. But there may be some clues that your discomfort stems from fear and not something else. (Here are the symptoms of an anxiety disorder you should know.)

Anxiety is a response to stress (real or imagined) and it’s not always a bad thing. A little fear keeps you on your toes — helping you meet a deadline, stick up for appointments, and follow the speed limit. Too much anxiety, on the other hand, can be debilitating and must be dealt with.

(Here’s the difference between stress vs. anxiety.)

Chest Tightness and Other Symptoms of Anxiety

Chest tightness is just one of many possible ways anxiety can manifest itself. “The classic anxiety symptoms are thoughts or fear of death, inability to sleep, inability to concentrate,” says Pedro Cazabon, MD, medical director of primary care at Ochsner Health. You may also experience muscle aches, body aches, inability to relax, shortness of breath, feeling tired and irritable, difficulty sleeping, rapid breathing, sweating or shaking, even gastrointestinal complaints.

“There is a real physiological change when we have a stress response,” says Brittany LeMonda, PhD, a senior neuropsychologist at Lenox Hill Hospital in New York City. “It’s really not necessarily an emotion experience, it’s [also] a physical experience.” (Check out these weird anxiety triggers, too.)

Why does anxiety lead to chest tightness?

Different processes work together to create different symptoms of anxiety, including chest tightness (which is also often accompanied by chest pain or pressure). One of these relates to hormones.

“When you feel a threat or fear, that triggers a release of adrenaline hormone,” explains Dr. Cazabon out. “Your heart rate goes up, your blood pressure can go up. your vascular [blood] barrels could be a little tighter. The pectoral muscles can also tighten and can make you feel like something is squeezing,” he says. The stress hormone cortisol also plays a role.

muscle tension

“The rib cage and diaphragm are all made of muscle and bone,” says Bradley Gaynes, MD, a professor of psychiatry and epidemiology at the University of North Carolina School of Medicine, in Chapel Hill. “You can get tense there too. And that’s why your chest could feel [tightness] and pain and shortness of breath.” It’s not much different than stress-related pain and tightness in your neck or shoulders.

Oxygen uptake

When you’re feeling anxious, you’re taking fast, shallow breaths, which means you’re not getting enough oxygen. Your body responds to this by taking even shorter breaths, which creates a vicious circle. This can also contribute to chest tightness, Dr. Gaynes says.

(Note the silent signs of high-functioning anxiety, too.)

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What else can make your chest feel tight?

Causes of chest tightness range from the relatively benign indigestion to a gallbladder attack to a potentially life-threatening heart attack or a pulmonary embolism (clot in your lung), says Dr. Cazabon. That’s why it’s such a difficult diagnosis to make.

Why is chest tightness associated with so many ailments? “The chest and upper abdomen are integrated from one nerve,” explains Dr. Cazabon out. “The vagus nerve [the 10th cranial nerve that supplies the heart, chest, and other organs] travels from the brain all the way to the GI tract, but it only registers non-specific pain.” You need to know more about the story to find a reason.

(Here are eight chest pains you might mistake for a heart attack.)

Is it fear or something else?

Because so many things can cause chest tightness, it’s one of the trickiest symptoms to diagnose, Dr. Cazabon says.

One way to suspect it is fear is to think about what is happening in your life right now. “Is there an obvious stressor that could explain why you’re more anxious?” says Dr Gaynes. Problems at work or in a relationship can help explain the symptom. The same goes for feelings of fear.

Other clues

Think about possible physical causes for your symptoms. Chest tightness is less likely to be associated with anxiety if you have a personal or family history of medical problems such as heart attacks or blood clots, Dr. Gaynes says.

If you can reproduce the feeling of tightness by pressing your chest, it’s less likely to be a heart attack and more likely to be a musculoskeletal problem, possibly from anxiety, says Dr. Gaynes.

Chest tightness that develops after exercise is more likely related to your heart, LeMonda says. Pain that lasts only about five to 10 seconds is more likely to be anxiety, she adds.

Assess cause

If you have any doubts about the cause of your tight chest, get input from a medical professional. It’s much easier today than it ever was. You used to have to make an actual appointment with a doctor or go to the emergency room. Today, there are less onerous options, Dr. Cazabon says. Many health systems have telemedicine capabilities, such as calling a hotline and talking to a nurse or taking a video call. (Here are five telemedicine apps you should know.)

“You don’t necessarily have to run to the emergency room or go to the doctor to get help,” says Dr. Cazabon. “There are plenty of places where you can get advice. Together with you, they determine the cause and determine the next step.” (Here’s what you need to know about chest pain that comes and goes.)

How to relieve chest tightness and anxiety?

But if you’re sure your symptoms are anxiety, the cure can be deceptively simple. Top of the list: Shifting your breathing from short, shallow breaths to longer, deeper ones, perhaps through mindfulness or meditation. “That can help you get more oxygen, which can calm your lungs and keep your chest from feeling so tight,” says Dr. Gaynes.

If something specific is stressing you out, “talk” to yourself using some cognitive behavioral (CBT) techniques to relax. For example, how likely is it that a doomsday scenario you imagine will happen? Would it be the end of the world if it did? CBT can also help you unlearn fear that has an external trigger.

Excercise

For our ancestors, the fight-or-flight response was meant to physically get you away from or face a threat. It is unlikely that you will encounter the same type of threat today (e.g. a lunging tiger). But you can still use exercises to wear out the response, as it were. “This can help reset your fear center,” explains Dr. Cazabon out. Try walking, running, climbing stairs, or hitting a punching bag. (Also, try these breathing exercises for anxiety.)

medication

Medicines to treat anxiety are usually a last resort. “I always think it’s better to find a way to manage anxiety without medication, because the medication puts a band-aid on things,” LeMonda says.

But if absolutely nothing else works, there are medications, including certain SSRIs (selective serotonin reuptake inhibitors), that are believed to help regulate mood and anxiety, Dr. Cazabon says.

Then read these therapist tips for coping with anxiety.

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