Chest Pain due to anxiety is a always diagnosis of exclusion.  It may feel pleuritic if associated with hyperventilation.  But it will be intermittent, as opposed to frank lung disorders that cause continuous, ongoing pain.  Consider anxiety as a cause of intermittent pleuritic chest pain that doesn’t seem musculoskeletal.  But don’t confuse causality — a patient with benign thoracic muscle strain may be quite anxious about their heart.

Only consider anxiety as a cause of non-pleuritic chest pain if:
  • Coronary disease unlikely by risk factor analysis; OR
  • Chronology & Duration not compatible with angina / infarction, AND
  • Pain isn’t associated with exertion.

Patients with panic disorder may experience chest tightness, along with palpitations, diaphoresis, sensation of suffocation, nausea, lightheadedness, tremor, and/or intense fear.  Less acute anxiety may also cause chest pain.  But remember, an M.I. can cause anxiety.

Other Clues:  Lack of exertional exacerbation, and sometimes tingling in the hands and mouth [symptoms of hyperventilation, not pathologic dyspnea].  Same-day Cocaine or Meth can cause both panic & infarction.

See postings Chest Pain – 2 and Chest Pain – 3.