Can Stress Cause Chest Pain?

Chest pain describes any sort of discomfort that happens in the chest area. And broadly speaking, the chest includes anything from the lower rib cage to just below the jaw. Most of us will experience some type of discomfort in this part of the body at some point, but it can be hard to know the cause and what it means.

One important trigger of chest pain is stress, which can bring on pain in a variety of ways. In this article we will explore how and why this happens — and when you should seek medical help.

What causes chest pain?

Not surprisingly, there are many different things that can cause pain in the chest. Some causes, like conditions that affect the heart and lungs, can be serious. Others are uncomfortable but less likely to cause serious harm. Because there are so many potential causes of chest pain, it can be tricky to tell the difference without the help of a medical professional. 

Some of the conditions that can cause chest pain include:

• Problems with the heart and blood vessels, such as:

  • Blockage in the heart arteries, including heart attack

  • Inflammation around the heart

  • Irregular or skipped heartbeats

  • Damage to the aorta, the main blood vessel that comes out of the heart 

• Lung issues, such as:

  • Blood clot in the lung (pulmonary embolism)

  • Inflammation of the lining of the lungs (pleurisy)

  • Pneumonia and bronchitis

• Hyperventilation, often from a panic attack

• Indigestion and peptic ulcers

• Muscle strain or tightness

• Inflammation of the soft tissue between the ribs (costochondritis)

• Injury to the chest or upper abdomen

• Arthritis of the spine

• Drug use, including amphetamines and cocaine

Why does stress make your chest hurt?

Your body may react to stress in a wide variety of ways. When you feel stressed, your body often releases stress hormones. You may have heard of adrenaline and cortisol, but there are several others. 

These hormones will pump up your blood pressure and make your heart race within a matter of seconds. As a result, your chest may feel uncomfortable. Your mouth may get dry, you may feel sweaty, and you may have a hard time concentrating. This is what we call a “fight-flight-freeze response,” and it evolved to help you escape from danger.

This stress reaction can be helpful if a predator is chasing you. But it isn’t such a good thing when the stress is caused by something like an argument, a deadline at work, or fears over things you can’t control.

Stress may also cause chest pain by triggering:

• Hyperventilation (rapid, shallow breathing)

• Tightening of chest muscle  

• Spasm of the esophagus

Unfortunately, stress can sometimes put a lot of strain on the heart. This can happen in several different ways: 

• In people who already have blocked coronary arteries, the high blood pressure and heart rate from stress may overwork the heart. This can lead to an angina attack or even a heart attack.

• The stress hormones themselves can cause spasm of the arteries that supply the heart.

• Stress can cause irregular heart rhythms, such as atrial fibrillation or premature contractions. 

• A rare stress reaction — broken heart syndrome — can cause the heart muscle to suddenly become weak and inflamed, and it may mimic a heart attack.

How can you tell the difference between stress and other chest pain?

It isn’t always easy to tell the difference between pain from stress and other types of chest pain. In general, pain from a heart condition comes on with exercise or stress, and it improves with rest. Usually it isn’t worse with specific stretches or movements. Heart pain commonly lasts for minutes or longer, not seconds. The pain may spread into the arms, jaw, or back, and it’s sometimes associated with nausea and vomiting. 

Pain from lung conditions — including blood clots — is usually continuous and worse with deep breathing. Heart and lung conditions may also cause shortness of breath, especially with exertion.

Pain from indigestion or ulcers often gets worse with eating or drinking.

Pain from muscle strains and costochondritis tends to worsen with deep breathing and often makes the chest tender to touch.

While these differences are helpful in sorting out the cause of pain, it’s important to understand that they are generalizations. So they may not apply to every situation. If you think your chest pain might be serious (more on this below), it’s best to consult a healthcare provider.

When should you seek medical help for chest pain?

It’s best to get help right away if your pain: 

• Doesn’t go away

• Comes on frequently

• Happens with exercise or stress

• Is associated with shortness of breath

Chest pain can happen for many reasons, and it can be scary. So it’s not surprising that it is the second leading cause of emergency room (ER) visits. 

The good news is that chest pain usually isn’t a sign of anything dangerous. In a review of over 42 million ER visits for chest pain, life-threatening conditions accounted for less than 6% of the visits. 

Nevertheless, it’s important not to ignore symptoms, since heart and lung problems can be deadly. That’s especially important if you’re over 50 — or if you have conditions that put you at higher risk for heart and lung problems, such as: 

• Diabetes

• High blood pressure 

• High cholesterol 

• Tobacco or illicit drug use

• Cancer

• Recent hospitalization or surgery

What is the treatment for stress-related chest pain?

When it comes to stress-related symptoms, getting to the root of the problem is crucial. Although we can’t always fix the cause of stress in our lives, identifying the source is the first step. Sometimes simply getting a little insight can make it less overwhelming.

Once you know the cause, then you can tailor the next steps to the problems at hand. Things that can make a difference by reducing the physical and mental impact of stress include:

• Management of the underlying stress, with professional help when needed

• Regular exercise

• Yoga and mindfulness practices

• Stretching and physical therapy when needed

When life is busy and time is limited, it can be tough to make the time for self-care. But taking these steps may help you sleep better, give you more insight into the conditions that contribute to stress, and help you find a way through any problems that are holding you back. In the long run, taking care of stress now may have important health benefits that will impact your future well-being.

Why trust our experts?

Written by:

Sarah A. Samaan, MD

Sarah Samaan, MD, FACC, FACP, FASE is a board-certified cardiologist who practiced clinical cardiology for nearly 30 years. She is a member of the American College of Cardiology, the American College of Physicians, and the American Society of Echocardiography.

Edited by:

Mandy Armitage, MD

Mandy Armitage, MD, has combined her interests in clinical medicine with her passion for education and content development for many years. She served as medical director for the health technology companies HealthLoop (now Get Well) and Doximity.

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