What The Term Anxiety Means?
The word “anxiety” is used to describe a feeling which people experience while facing fear, danger or some stressful conditions like losing a job, broken marriage or death of a loved one. Anxiety can express a person’s feeling of being tensed, uncomfortable or restless.
We all may have experienced some form of anxiety in our lives. When anxiety is restricted to an acute phase of stress or fear, it is considered as a person’s normal reaction. It is called abnormal when anxiety persists even after the triggering phase is over.
Research studies conducted all over the world conclude that 1 out of 14 people meet the diagnostic criteria for anxiety disorders. It affects nearly 12% of population worldwide resulting in mild to severe impairment.
Can Anxiety Cause Chest Pain?
Non-cardiac chest pain is one of the most frequent complaints seen in the emergency department. Chest pain caused by anxiety is characterized by:
- Sharp in nature
- Non-radiating or radiating to right arm
- Occurring on left side of the chest
- Substernal pain brought on by exertion and not relieved from rest
Chest pain episodes are definitive criteria to diagnose patients with panic attacks. Panic attacks are also the most common type of anxiety disorder associated with chest pain, occurring in about 78% cases. Chest pain is more common among sudden-onset panic attacks as compared to those attacks which have a gradual onset
Some Possible Reasons behind Chest Pain Due To Anxiety are:
- Tachycardia – in patients with panic disorders, tachycardia (fast heart rates) is seen. Tachycardia results in increased oxygen demands and less blood supply.
- Coronary Artery Disease (CAD) – a certain amount of co-relation was found to exist between panic disorder and coronary artery disease.
Researchers have raised a possibility that sudden attacks of anxiety can result in development of coronary artery disease through its relationship with cardiac risk factors. Asymptomatic Mitral Valve Prolapse (MVP) in seen in nearly 10-20% patients having chest pain due to anxiety.
It has been observed in a large group of patients having chest pain due to anxiety that they are convinced that they have some major disease. Patients with anxiety disorders having chest pain are reportedly more distressed than patients who actually have a cardiac illness.
The complaint of chest pain compels patients to seek treatment for their anxiety. This is the reason why nearly 9% of patients having anxiety disorders seek cardiologist’s help for chest pain. Conversely, panic disorder can be noticed in patients having both cardiac and non-cardiac type of chest pain.
Can Anxiety Cause Chest Tightness?
The symptoms of anxiety can be different for different individuals. While some may experience sudden chest pain due to anxiety, others may find it difficult to breathe during these attacks.
Chest tightness can be presented as shortness of breath, difficulty in breathing, feeling out of breath, and feeling suffocated, gasping of air and becoming conscious of your breathing. Chest tightness is a common symptom of anxiety. Chest tightness caused by anxiety has the following features which can differentiate it from cardiac causes:
- Associated with nervousness
- Related to meals or dyspepsia
- Numbness or coldness of hands and feet
Few possible reasons why one may experience chest tightness due to anxiety are
- Micro-Vascular Angina – hyperventilation seen in sudden panic attacks and anxiety results in sudden increase in workload of the heart and lungs.
It was found recently, patients with sudden attacks of anxiety showed increase in formation of fibrin (forms clots). This causes spasm of capillaries and arterioles giving a feeling of chest tightness.
- Hyperventilation – patients, who are already highly anxious, may experience chest tightness due to increased chest wall activity following carbon dioxide inhalation. This can also precipitate chest pain due to anxiety.
- Increase in Blood Pressure and increased oxygen demand of heart during anxiety or panic attacks can cause chest tightness or shortness of breath.
- Tightening or Contraction of Muscles – in people who experience anxiety attacks infrequently, their body gets sufficient time to relax. This relaxation time is restricted or absent in people who experience anxiety attacks frequently.
In contrast, the symptom of chest tightness itself can aggravate other symptoms related to anxiety.
Treatment For Chest Pain and Tightness Caused By Anxiety
Treatment For Chest Pain Caused By Anxiety:
Chest pain during anxiety has been linked to reduced quality of life, dissatisfaction with life and poor physical, mental and social health status. It is also linked to frequent hospitalization, increased expenditure on seeking medical consultations and medications.
It is important to differentiate cardiac causes of chest pain from non-cardiac causes. Treatment for chest pain due to anxiety includes:
- Counseling and Behavior Therapy – Counseling and behaviour therapy works beneficially in patients facing frequent attacks of anxiety:
- It helps them to identify their triggering factors.
- Behavioral therapy helps the patients manage and reduce their own symptoms.
- It helps them understand that chest pain caused due to anxiety is not of cardiac chest origin.
- Inculcating– positive thinking enables patients to face anxiety and yet manage their symptoms. This prevents occurrence of chest pain.
- Count – counting gradually from 1 to 10 during anxiety attacks helps to deviate the mind from triggering factor.
- Deep Breathing – as we have seen that chest pain can occur due to reduced blood supply to smaller arteries, breathing in and out gradually during panic attacks helps in maintain a normal flow of blood.
- Keeping Track of Attacks – this helps the patient and even the doctor to evaluate how behavior and counseling therapy or medications have been working well to treat chest pain during anxiety.
- Lifestyle Modifications Include:
- Getting proper sleep
- Daily physical exercise
- Eating a healthy well-balanced diet.
It is important to recognize that untreated frequent anxiety attacks causing chest pain can actually precipitate a cardiac illness in the long run
Treatment For Chest Tightness Caused By Anxiety
It is essential to identify chest tightness caused by anxiety and to differentiate it from other respiratory causes to provide appropriate treatment for the same. Treatment for chest tightness caused by anxiety includes:
- Behaviour Therapy– Helps the patient in following ways:
- It is important to remind the patient that this feeling of chest tightness caused by anxiety is temporary and not due to any cardiac or respiratory cause.
- It helps the patient to identify triggering factors and how to manage the feeling of chest tightness in presence of these triggers.
- Deep Breathing– Exercises for relaxation helps the patients to maintain and regulate normal respiration even when they are faced with anxiety.
- Sit in a relaxed position and close your eyes. Breathe in gradually. Hold your breath for 2-3 seconds and slowly exhale. Repeat this up to 10 times or until you fell at ease.
- As you breathe in and breathe out, count your breaths. This not only helps you focus on your breathing, but also deviate your mind from anxiety triggers.
- Breathing exercises increases the amount of oxygen supply to the brain and helps you calm down.
- Inculcate Positive Thinking– This helps the patient manage and control hyperventilation caused due to anxiety.
- Keep track of attacks and note down the severity of chest tightness experienced during each anxiety attack. This helps to analyze how well behavior therapy has been working.
- Lifestyle modifications similar to the ones mentioned above can be used to additionally help control chest tightness due to anxiety. Quitting cigarette smoking and alcohol helps to avoid developing actual respiratory or cardiac illnesses later in life.
- Medications may have to be used if the patient is already suffering from some chronic lung disorders like bronchitis or asthma.
Although mental illnesses are considered a taboo worldwide, it is important to understand that anxiety disorders are related to disturbed mental health and appropriate medical help must be sought to ease anxiety and chest pain and tightness related to it.
Dr. Himanshi is a Homoeopathic consultant and currently working as a lecturer in Post-graduate faculty of Homeopathy, Parul University, Vadodara. Completed BHMS and MD in Homeopathy in January 2018 and also has a clinical experience of about 6 years. Personal interests include reading, spending time with family and traveling.