Tightness in Chest with Anxiety

Chest Tightness

Many people live on the edge of anxiety to one degree or another. Often recurrent or persistent stress, or other underlying causes of anxiety, can lead to chest tightness or pain. Symptoms of chest tightness due to anxiety can mimic symptoms of serious medical conditions and it is not always easy to tell the difference. When in doubt, especially if tightness in chest with anxiety is associated with other symptoms, it is important to seek prompt medical help.


Anxiety by itself can lead to chest tightness as a common symptom. In addition to anxiety and anxiety disorders, any structure in the chest and upper abdomen can also cause tightness in the chest accompanied by anxiety, including the heart, lungs, trachea, esophagus, liver and gallbladder.

Learning some of the differences between anxiety-generated chest tightness and that caused by more serious medical problems, such as heart disease, can be helpful and life-saving when you are faced with these symptoms.

Anxiety Disorders

Anxiety can stem from mild, short-lived responses to a threatening situation, which is a normal aspect of survival instincts. Symptoms of anxiety also can be part of a range of persistent anxiety or psychiatric disorders, such as:

Whatever the cause of the cause, common symptoms of anxiety include:

  • Chest tightness or pressure
  • Generalized tightening of muscle groups leading to headache, neck pain, pain at the base of the neck or back pain
  • Difficulty breathing, or shortness of breath and feelings of suffocating
  • Feelings of panic usually because of the difficulty breathing
  • Rapid breathing (hyperventilation)
  • Rapid heart rate
  • Sweating
  • Shaking
  • Difficulty concentrating or performing normal daily functions
  • Varying degrees of fear or feelings of impending doom or death
  • A focus or fixation on the symptoms

Sometimes there is numbness and tingling in lips, fingers and feet because of the shallow, rapid breathing and inadequate oxygen.

The chest tightness is usually the result of holding chest muscles and rib cage muscles tight, or the disordered breathing.

Cardiovascular Disease

The symptoms associated with heart disease or a heart attack are often varyingly described as follows:

  • Tightness, pressure, squeezing, or pain mid chest
  • Pain may radiate to the shoulders, arms, jaw, neck, back, or upper abdomen
  • May be accompanied by shortness of breath or difficulty breathing
  • Irregular or rapid heart rate may be present
  • Nausea and vomiting can occur
  • There may be sweating, light headedness, and fainting, or loss of consciousness
  • Skin may become pale, sweaty, clammy, or cold
  • Feelings of panic
  • May be accompanied by feelings of anxiety, fear or impending doom or death

Other diseases associated with the heart and blood vessels, including a tear in the aorta due to ruptured aneurysm and pericarditis, (an inflammation of the outer lining of the heart), can cause symptoms similar to a heart attack. A ruptured aortic aneurysm is often associated with a sudden severe pain in the back.

Because the symptoms of an anxiety attack and a heart attack or other cardiovascular event are similar, it is better to be cautious and seek immediate help, especially if you have risk factors for heart disease such as diabetes, high blood pressure, obesity and smoking.

Lung Disease

Lung or pulmonary disease often leads to shortness of breath, and this symptom can lead to tightness in the chest with anxiety as associated symptoms. These lung diseases include

  • Asthma
  • Pneumonia
  • Bronchitis
  • Pulmonary embolus, a blocking of blood vessel(s) in the lungs resulting in poor oxygen supply to the blood
  • Pleurisy, an inflammation of the outer covering of the lungs

A pulmonary embolus or an acute asthma attack can quickly lead to death because of lack of adequate oxygen, so, again, it is important to seek emergency treatment.


Costochrondritis, a chronic inflammation of the muscles of the ribs and sternum or persistent contraction of these muscles due to stress, can also lead to chest tightening or pain which my lead to anxiety and mimic symptoms of heart disease. Often these symptoms can be relieved with an anti-inflammatory medicine.

Gastrointestinal Disease

An inflammation of the lining of the esophagus (esophagitis) and the stomach (gastritis) can lead to mid-chest tightness or pain, difficulty breathing and anxiety, in addition to abdominal pain, that can mimic symptoms of heart disease. The symptoms are usually worse after eating and can decrease by taking an antacid.

Stones or inflammation of the gallbladder can also lead to referred chest tightening or pain in addition to abdominal pain.

Treatment of Anxiety-Related Chest Tightness

Tightness in the chest with anxiety due to an anxiety disorder can be treated with medicines, or psychotherapy, or both. A doctor may prescribe a muscle relaxant, or an antidepressant or both, depending on the cause of the anxiety. In the event of an underlying anxiety or panic disorder, ongoing psychotherapy is essential in treating the root cause.

Treatment of other underlying causes of chest tightness or pain and anxiety, such as gastrointestinal disease or costochondritis, is also important to eliminate these as contributing factors to your symptoms when they reoccur.

Living and Coping With Anxiety

Learning to cope with and manage episodes of anxiety attacks is important to your well-being. You can control and decrease anxiety symptoms and frequency of recurrences by practicing slow, deep breathing and relaxing your chest and other muscles, or by other relaxation techniques.

The Relaxation Response is a powerful relaxation technique developed at Harvard Medical School that you can learn and use anytime necessary. Practice this technique so you can easily use it if you feel an impending attack or to reverse an attack. There are also other relaxation techniques that can reduce symptoms and improve your ability to cope.

Managing an Attack of Anxiety

Anxiety in its varying degrees can lead to chest tightness or pain, and chest tightness or pain can lead to anxiety. In either case, you can rapidly enter a cycle where it is difficult to sort out cause from effect. Fears of whether or not you are having a heart attack and feelings of impending death can amplify any of the symptoms that accompany these scenarios. It is easy to lose control during these episodes which can lead to further panic.

Seek Medical Attention When Necessary

Learn ahead of time how to cope with these episodes and do not hesitate to seek emergency medical attention if you are at all uncertain about the cause of your symptoms. Often the assurance of a negative workup for underlying cardiovascular disease, a heart attack, or other serious illness can lead to a decrease in anxiety symptoms and fear of recurrent attacks.

Tightness in Chest with Anxiety