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Understanding Anxiety

Anxiety Chest Pain: Why It Happens and Why It's Not Your Heart

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6 min read

13 November 2025

Chest pain is one of the most alarming symptoms of anxiety — and one of the most common. Many people who experience anxiety chest pain make repeated visits to A&E, convinced they are having a heart attack. The ECG comes back normal. The blood tests are clear. The doctor says it's anxiety. And then it happens again.

What Causes Anxiety Chest Pain

Anxiety chest pain is produced by several mechanisms working simultaneously:

Muscle tension — the chest wall and intercostal muscles become chronically tense during anxiety, causing aching, tightness, and sharp pains
Hyperventilation — rapid or shallow breathing changes blood CO2 levels, causing chest tightness and pain
Costochondritis — inflammation of the cartilage connecting ribs to the sternum, commonly triggered or worsened by anxiety
Adrenaline — the stress response increases heart rate and blood pressure, creating palpitations and chest discomfort
Oesophageal spasm — anxiety can cause spasms in the oesophagus that feel identical to cardiac chest pain
Heightened interoception — anxiety makes you more aware of normal bodily sensations, amplifying discomfort

How to Tell Anxiety Chest Pain from Cardiac Chest Pain

If you have chest pain and have not been evaluated by a doctor, please do so — particularly if you have risk factors for heart disease. However, anxiety chest pain typically: comes and goes; worsens with anxiety or stress; is associated with other anxiety symptoms (shortness of breath, palpitations, dizziness); does not radiate to the arm or jaw; does not worsen with physical exertion; and resolves when anxiety reduces.

If in doubt, get checked

Anxiety chest pain is harmless. Cardiac chest pain is not. If you haven't been evaluated, see your doctor. Once cardiac causes have been ruled out, understand that your chest pain is a symptom of anxiety — and it will resolve when the anxiety does.

Ending Anxiety Chest Pain

Anxiety chest pain resolves completely when anxiety resolves. It does not require separate treatment. It is not a sign of damage or disease. It is a physical symptom of a biological alarm system running at the wrong level — and when that level is corrected, the chest pain, like all other anxiety symptoms, disappears.

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Understanding Anxiety

Charles Linden

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