ANXIETY CHEST PAIN

 

Overview

Chest pain is considered a dangerous symptom. It is primarily considered a symptom of heart diseases specifically Myocardial Infarction which is also referred to as heart attack in layman terms. Chest pain is a feeling of discomfort, heaviness or throbbing pain in the left side of the chest where the heart is anatomically located. During a myocardial infarction, the blood supply to the heart muscles is compromised resulting in damage to the heart muscles and often death of these tissues or parts thereof which manifests with the characteristic symptom of chest pain. Not all heart attacks result in chest pain, there can be silent heart attacks as well or with those having a range of symptoms other than the characteristic chest pain. Similarly, not every episode of chest pain is due to a heart attack! One of the hallmarks of anxiety and panic disorders is experiencing chest pain, very similar in nature to the one experienced due to myocardial infarction. This is often confused by the patients of anxiety as a pain of cardiac origin. Therefore this article is dedicated to anxiety induced chest pain, the associated symptoms, causes, treatments and home remedies in this context.

 

Understanding chest pains

In order to understand anxiety chest pain further, we shall have a look at the causes of chest pain in general. The common causes of chest pain are as follows:

1.    Myocardial infarction or heart attack: by far this is the leading cause of chest pain.

2.    Other heart and circulatory conditions leading to chest pain are

i.    Myocarditis, which is an inflammation of the muscle tissue of the heart

ii.    Pericarditis, which is an inflammation of the covering of the heart, the pericardium.

iii.    Cardiomyopathies, which are hereditary diseases leading to the destruction of the heart muscles.

iv.    Valvular disorders of the heart. As you may know, the heart has a set of valves inside it which control the regurgitation of blood while the heart relaxes. In case of Valvular disorders, the symptom of chest pain is often produced.

v.    Congenital heart diseases. Congenital heart diseases are defects in the development of heart present since birth. These defects include the atrial and ventricular septal defects which are often referred to as holes in the heart. They often produce the characteristic chest pain once the defect or hole gets big enough to cause abnormalities in the function of the heart.

vi.    Aortic coarctation. Aorta is the main blood vessel supplying blood from the heart to the various tissues and organs of the body. In some cases, it becomes narrow and this narrowing is termed as coarctation. This leads to severe chest pain.

3.    Conditions related to the lungs:

i.    A chronic cough due to respiratory tract infections

ii.    Pneumonia

iii.    Tuberculosis

iv.    Asthma

v.    Pulmonary embolism, a phenomenon in which a clot travels through the blood vessels to the lungs and gets lodged there, often obstructing the blood flow to the lungs. This can result in severe chest pain and breathlessness.

vi.    Air in the chest termed as pneumothorax. In this condition, an injury to the chest cage leads to accumulation of air in the chest cavity and this manifest as severe and throbbing chest pain.

4.    Gastrointestinal causes of chest pain:

There are a variety of gastro-intestinal (digestive) system causes of chest pain. These include:

i.    Dyspepsia or indigestion

ii.    Acid Reflux due to retrograde movement of acid from the stomach to the mouth.

iii.    Inflammation of the food pipe (esophagitis)

iv.    Excessive gas in the digestive system

5.    Chest pain is often of a muscular origin and therefore can be termed as a muscular pain. Muscles lining the chest cage undergo spasm or undue contraction which results in such symptoms.

6.    Anxiety and panic disorders. Once all the other causes of chest pain are ruled out, the possibility of chest pain due to an underlying anxiety or panic disorder is examined. For the later part of this article, we shall focus on the chest pain produced as a result of anxiety and panic disorders.

 

Symptoms of anxiety chest pains

Anxiety chest pain has the general characteristics of chest pain due to any of the causes described above. However, some of the notable features of anxiety chest pains are as follows:

1.    It is a sharp and throbbing pain on the left side of the chest

2.    Can be associated with heaviness or tightness in the chest

3.    Many people refer to it as being of a dull and aching origin, with persistent low to moderate level pain continuing for extended periods of time

4.    Others may describe it as being as intense as stabbing.

5.    It may radiate to the jaw or the left arm.

Anxiety chest pain is not often a solitary symptom. It is accompanied by a variety of other symptoms which include the following:

i.    Heartburn or symptoms of acid reflux from the stomach which is belching, bloating and feeling a bad taste in the mouth and having a burning sensation in the food pipe.

ii.    Palpitations and skipping the heartbeat. These are strange symptoms of being aware of the heartbeat and feeling abnormalities in the rate and rhythm of the contracting heart.

iii.    Shortness of breath or a feeling that one is not able to breathe properly

iv.    A rapid heartbeat greater than 100 beats per minute. This condition is referred to as tachycardia.

v.    Trembling is also commonly accompanied by chest pain in anxiety.

vi.    Profuse sweating also accompanies the chest pain in anxiety. Specifically sweating occurring in the palms of hands and soles of feet is characteristic of anxiety

vii.    Lightheadedness, a feeling of dizziness and feeling that the head is light and without any weight.

viii.    An intense and throbbing headache can often accompany anxiety chest pain.

ix.    Increased frequency of urination also occurs as a symptom of anxiety, even in the absence of an enhanced fluid intake.

x.    Diarrhea or lose motions also accompany chest pain if it is of anxious origin.

One important characteristic of the anxiety chest pain symptom is that it is like a vicious cycle. It is a vicious cycle in the sense that it is anxiety which induces the chest pain and once it is there, the chest pain on its own precipitates more anxiety. The sufferer thinks he or she is having a heart attack and his anxious mental state predisposes him or her to believe that the chest pain is due to an active or impending heart attack which leads to more anxiety. This vicious cycle leads to a lot of exaggeration of the symptoms unless addressed properly.

Keeping in view the mechanism of this vicious cycle, it is very important for everyone especially those suffering from anxiety disorders to be able to differentiate between chest pain due to heart or cardiac reasons and that because of anxiety. Some of the differentiating points are described below (these are for reference only and cannot undermine the importance of a prompt medical advice by a qualified medical practitioner):

i.    In a heart attack, the chest pain is either produced or worsened by physical activity and exertion. However, this is not the case with anxiety chest pains. It comes on spontaneously and exertion and activity seem to have little or no effect on aggravating or relieving it.

ii.    In a heart attack, chest pain is often absent in a state of rest as described above. However, there is one exception to this rule. In a condition called unstable angina, the chest pain often begins at rest. However, in anxiety chest pains, the pains almost always start in a resting phase.

iii.    In chest pain due to heart attack, most of the symptoms we have described which accompany anxiety chest pain are not present. However, in anxiety chest pain, a host of other accompanying symptoms is always present.

iv.    The chest pain of heart attack is constant and nearly permanent unless medical intervention is made. Sublingual tablet (angised) or nitroglycerin spray administration if used in chest pain due to heart attack often reduces the severity of pain in case of heart attack and this in itself is diagnostic of a heart attack. However, anxiety chest pain does not respond to such medical interventions designed to address the functioning of the heart.

Now that we have an insight into the various symptoms accompanying anxiety chest pain, let’s have a look at the causes of anxiety chest pain.

Causes of anxiety chest pain

Anxiety results in chest pains as we described above and the causes of chest pain due to anxiety are both physiological as well as psychological as we describe in the paragraphs to follow.

First of all, we will consider the physiological or functional causes of chest pain due to anxiety. Anxiety results in chest pain with a specific mechanism which leads not only to chest pain or tightness but to a host of other signs and symptoms which have already been described above. In order to understand how anxiety causes chest pain the way we explained it for chest pain due to a heart attack or myocardial infarction in the early portion of this article, we need to understand the stress mechanism of our body.

When subjected to stress or an unusual condition or a circumstance which leads to alarming of the body for its defense, our body responds to the situation by initiating a stress response more appropriately termed as the fight or flight response. In this response, the body reacts to an impending danger by activating a component of the nervous system called the sympathetic nervous system as well as by the secretion of certain chemicals by the body called catecholamines, also called adrenaline. This response fastens the circulatory and respiratory systems to prepare the body for a stressful situation. As a result, the heart and breathing rates increase and our body starts burning glucose fast to provide all the resources for a quick and efficient response to the stress. The muscles of the body also get taut as a result of the response.

These changes often lead to changes in the circulation of blood to the body and narrowing of the blood vessels to various parts of the body including those supplying blood to the heart itself. The heart is already beating fast to cope with the stress and in the presence of these vascular changes and muscular changes, it leads to the sensation experienced as a chest pain. However, at this point, we need to focus that stress is a normal response to danger or an adverse situation. Anxiety, however, is only a perceived version of the danger which does not exist in reality. Due to this perception, anxiety invokes the stress response on its own without having a real-time stressor and produces all the symptoms of a stress response.

Chest pains experienced in anxiety are also attributable to psychological and emotional causes. Anxiety symptoms as we described take the form of a vicious cycle. Anxiety produces fear which leads to stress responses and the stress responses, in turn, produces more fear and resultantly greater levels of anxiety. People suffering from anxiety are prone to think they are having or going to have an adverse health outcome like a heart attack and this emotion or feeling results in the potentiation of the stress response. Feeling like one will have a heart attack actually causes one to perceive they are experiencing chest pain.

To conclude, these physiological, psychological and emotional causes initiate and exacerbate chest pain due to anxiety and should be clearly understood to differentiate with other conditions which lead to chest pain.

 

Treatments

Treatments for anxiety chest pains are essentially the same as treatments for anxiety disorders in general. Once anxiety is cured, chest pains due to anxiety vanish and if anxiety disorders are not managed properly, then anxiety chest pains exist and exacerbate along the course of the disease.

Treatment of anxiety begins with the diagnosis of the disease. Symptoms and signs of anxiety are brought about in any age of the lifecycle of a human being. The start is often insidious and anxiety attacks are infrequent in the beginning, but with the progression of the disease and over time, the symptoms become persistent, troublesome and disturbing. As we have already discussed, most of the symptoms of anxiety especially anxiety chest pain mimic the symptoms of a heart attack. There are many other disorders which produce anxiety-like symptoms as well. Therefore, if anyone has such symptoms, the first step is to see a doctor, most appropriately a general practitioner or a general physician first. The doctor will take a detailed history of the patient and carry out a comprehensive general physical examination to diagnose the cause of the symptoms. The doctor can also order a variety of investigations like blood and urine tests, radiological investigations like X rays and ultrasound examination to rule out any pathology which may be causing the symptoms. In case of anxiety chest pains, an electrocardiogram referred to as an ECG is the investigation of choice to rule out the causes of anxiety related to the heart. If required, further heart investigations like echocardiography may be advised to have a detailed look on the structure and function of the heart and rule out any causes which may be leading to chest pain experienced by the patient.

If any cause of chest pain or associated symptoms is found, the doctor will refer you to the appropriate specialist for treatment of the specific underlying cause of the symptoms. However, if any other cause is not found, the doctor may evaluate you for having an underlying anxiety or panic disorder which may be causing the symptoms in your case. Though a general practitioner or a general physician is knowledgeable enough to diagnose anxiety based on his or her clinical expertise, you may be referred to a psychiatrist for a more expert opinion and for confirmation of the diagnosis.

Once the final diagnosis of an anxiety disorder is made, the treating doctor shall initiate the treatment most appropriate for you. Treatment of anxiety is done using two methods which are medication and psychotherapy. We will consider both of them in the paragraphs to follow.

A lot of research has been done to cure anxiety disorders by the use of medication. Medicines which relieve anxiety are termed as anxiolytics and often promote sleep as well as relieving anxiety. Anxiolytics come in various classes the major ones being barbiturates and benzodiazepines (often called sleeping pills due to their sleep-inducing effects). These medicines are used to immediately relieve anxiety symptoms including anxiety chest pain and they start acting within minutes of their administration. However, they are not a long-term or permanent cure of the anxiety disorders and are reserved for the management of acute anxiety attacks only, and that too for a limited period of time because they result in tolerance and dependence which is harmful to those who are using them. Tolerance of a medicine is said to develop when with extended use of the drug over time, a greater dosage of the drug is required to produce the same effect. Similarly, the dependence of a drug develops when the person taking the medicine can no longer control the symptoms without the use of that drug. The phenomena of tolerance and dependence both occur together and are particularly associated with the use of barbiturates and benzodiazepines. Therefore, their long-term is neither advisable nor desirable.

The mainstay of drug treatment of anxiety is the use of antidepressant medication on a long term basis. Most effective class of drugs in this regard is the Selective Serotonin Reuptake Inhibitors (SSRIs) which are found to have excellent effects in curing or controlling anxiety disorders on a long-term basis. SSRIs, however, unlike the anxiolytics we described in the last paragraph are not quick acting and take some weeks of regular usage before any benefit is observed by the patients. However, once their levels in the body start building up, they are very successful in keeping anxiety symptoms like chest pain in check.

The other modality for anxiety treatment is psychotherapy carried out by a qualified therapist called a clinical psychologist who sits with the patient and discusses his condition with him. Exceptional results in anxiety treatment have been shown by the use of a special form of psychotherapy called Cognitive Behavioral Therapy (CBT). CBT aims are removing the harmful thought and behavioral patterns which give rise to anxiety. Psychiatrists use either medication, CBT or a combination of both the treatment modalities to treat anxiety. Anxiety chest pains respond very well to treatment of anxiety and in most cases cease to exist. In case they persist even after treatment, their intensity, frequency, and duration can be controlled considerably.

Home treatments

Once anxiety is diagnosed, a lot of things can be undertaken at home to relieve the symptoms of anxiety and anxiety chest pain. Some of them are as follows:

Ø  Deep breathing exercises: deep breathing exercises reduce stress, alleviate signs and symptoms of anxiety, bring the heart rate in the normal limits and ensure smooth breathing which is disturbed due to anxiety. Deep breathing if practiced properly and regularly at home prevents anxiety chest pains from occurring. Deep breathing is done by sitting in a quiet place in an upright position. Inhaling slowly while counting 1, 2, 3 and 4 corresponding to seconds, then holding the breath for 4 seconds and finally exhaling slowly for 4 seconds and simultaneously relaxing the body and mentally focusing one on being relaxed and free of worries.

 

Ø  Computer-aided relaxation techniques aid in relaxation at home. These include viewing guided soothing imageries as well as more comprehensive computer and mobile applications designed to relax when feeling anxious. A motivational and relaxing speech by a psychotherapist is often a part of these software applications and has an excellent soothing and relaxation effect.

Ø  Practicing meditation and yoga are also useful techniques for keeping calm and controlling the symptoms of anxiety.