Could Your Chest Tightness Be Due to Anxiety? Why It Happens

You should always take chest tightness seriously, but there are ways to help tell if it's from anxiety or something else. Here's what to know.

What is anxiety?

Almost 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 chest tightness, which can also be a sign of something more immediately life-threatening, like a heart attack.

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It’s always best to check with a doctor or nurse to determine the cause of your symptoms. But there may be some clues that your discomfort is stemming from anxiety and not something else. 

Anxiety is a reaction to stress (real or imagined) and it’s not always a bad thing. A little bit of anxiety keeps you on your toes—helps you meet a deadline, show up for appointments, and follow the speed limit. Too much anxiety, on the other hand, can be debilitating and needs to be addressed.

Chest tightness and other symptoms of anxiety

Chest tightness is just one of many possible ways anxiety can manifest. “The classic anxiety symptoms are thoughts or fear of death, inability to sleep, inability to concentrate,” says Pedro Cazabon, MD, system medical director of primary care at Ochsner Health. You may also experience muscle aches, body aches, not being able to relax, shortness of breath, feeling tired and irritable, trouble sleeping, rapid breathing, sweating or trembling, even gastrointestinal upset.

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

Why does anxiety lead to chest tightness?

Several processes act together to create different symptoms of anxiety, including chest tightness (which is also often accompanied by chest pain or pressure). One involves hormones.

“If you sense a threat or fear, that triggers a release of adrenaline hormone,” explains Dr. Cazabon. “Your heart rate goes up, blood pressure can go up. Your vascular [blood] vessels can tighten a little bit. The chest muscles can also tighten and can give you the feeling of something squeezing,” he says. The stress hormone cortisol also plays a role.

Muscle tension

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

Oxygen intake

When you’re feeling anxious, you take fast, shallow breaths which means you’re not bringing in enough oxygen. Your body reacts by taking even more short breaths which results in a vicious circle. This can also contribute to chest tightness, says Dr. Gaynes.

What else can cause your chest to feel tight?

Causes of chest tightness run the gamut from the relatively benign like 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 tricky 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. “The vagus nerve [the 10th cranial nerve that supplies the heart, chest, and other organs] travels from the brain all the way to the gastrointestinal tract, but it just registers nonspecific pain.” You need to know more of the story to zero in on a reason.

Is it anxiety or something else?

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

One way to suspect it’s anxiety is to think about what’s going on in your life at the moment. “Is there any kind of clear stressor that’s happening that might explain why you’re more anxious?” says Dr. Gaynes. Trouble at work or in a relationship may help explain the symptom. So may feelings of fear.

Other clues

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

If you can reproduce the feeling of tightness by pushing down on 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 comes after physical exertion is more likely to be related to your heart, says LeMonda. Pain that lasts only about five to 10 seconds is more likely to be anxiety, she adds.

Assessing the cause

If you have any doubt at all about the cause of your tightening chest, you need to get input from a medical professional. That’s much easier today than it once was. In the past, you had to make an actual appointment with a doctor or trek to the emergency room. These days, there are less onerous options, says Dr. Cazabon. Many health systems have telemedicine capabilities, like calling a hotline and talking to a nurse or doing a video visit. 

“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. They will determine the cause with you and determine the next step.” 

How to relieve chest tightness and anxiety

But if you’re certain your symptoms are from anxiety, the remedy can be deceptively simple. At the 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 help your chest not feel as tight,” says Dr. Gaynes.

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

Exercise

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For our ancestors, the fight-or-flight response was supposed to get you physically away from a threat or confront it. You’re unlikely to face the same kind of threat today (a lunging tiger, for instance). But you can still use exercise to wear out the response, so to speak. “This can help reset your anxiety center,” explains Dr. Cazabon. Try walking, running, climbing stairs, or punching a bag. 

Medication

Drugs 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 is putting a Band-Aid on things,” says LeMonda.

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