When Anxiety Affects the Heart: Understanding Chest Pain That Isn’t Cardiac
Chest pain is one of the most frightening physical sensations a person can experience. For many people, the first thought is that something serious must be wrong with the heart. After medical checks show that the heart is healthy, there can be relief, but also confusion and frustration. How can chest pain feel so real when the cause is anxiety? Understanding how the body responds to stress can help you make sense of these symptoms and begin to find lasting relief.
Why anxiety can cause chest pain
When we feel threatened or under pressure, the body releases adrenaline and other stress hormones. These prepare us to act quickly, tightening the muscles, speeding the heart rate and changing breathing patterns. If anxiety stays high for too long, this system can misfire, producing sensations that mimic cardiac symptoms. Tightness in the chest, breathlessness, palpitations, tingling in the arms or dizziness can all appear as part of the body’s natural alarm system. They are not dangerous in themselves, but they feel alarming because they resemble signs of a heart problem. The cycle that keeps symptoms going
Many people who experience anxiety-related chest pain find themselves caught in a loop. The physical sensations trigger fear, which increases the body’s adrenaline response, which then intensifies the symptoms. Thoughts such as “something must be wrong with my heart” feed the cycle, keeping the body on alert. Over time, this can lead to avoidance of exercise, social situations or stressful events for fear of triggering symptoms. Therapy helps you break this cycle by calming the body’s stress response and changing how you interpret physical sensations. After a clear cardiology assessment
It is essential to rule out cardiac causes for chest pain, and many people reach therapy after investigations such as ECGs, echocardiograms or stress tests show a healthy heart. At this point, it can help to think of anxiety not as “imaginary illness” but as the body’s protective system becoming overly sensitive. The same biological processes that help us run from danger can, under chronic stress, start firing even when there is no real threat. Understanding this helps shift the focus from fear of damage to learning how to regulate the system. How therapy helps
Therapy offers both physiological and psychological tools for managing these symptoms. In Cognitive Behavioural Therapy (CBT), you learn to recognise the links between thoughts, body sensations and behaviours. For example, noticing how shallow breathing and catastrophic thoughts feed the sense of tightness allows you to interrupt the pattern with calmer breathing and balanced thinking. Acceptance and Commitment Therapy (ACT) helps you focus less on controlling symptoms and more on living fully even when anxiety is present. Compassion-focused therapy supports you to meet your body’s distress with kindness instead of frustration, which itself reduces adrenaline and calms the system. Simple techniques that can help right now
- Slow breathing. Try inhaling gently for four counts, holding for two, and exhaling slowly for six. The longer out-breath activates the body’s calming system.
- Grounding attention. Notice five things you can see, four you can touch, three you can hear, two you can smell and one you can taste. This helps move your focus from internal sensations to the external environment.
- Gentle movement. Short walks or stretching can discharge built-up adrenaline and signal safety to the body. Avoid complete avoidance of exercise once your doctor has confirmed your heart is healthy.
- Reassurance through understanding. Remind yourself, “This feeling is my body’s alarm system, not a sign of harm.” Repeating this helps re-train the brain over time.
Integrating with medical care
Psychological therapy works best when integrated with your medical care. Cardiologists and GPs often refer patients for therapy when cardiac causes are excluded, but symptoms persist. This collaboration helps ensure that nothing physical is missed while also addressing the underlying anxiety that keeps the nervous system overactive. Therapy provides the missing piece of recovery, teaching your body to recognise safety again. Moving towards calm
Living with chest pain, even when you know it is anxiety-related, can be exhausting. Therapy offers a structured way to understand what is happening and to restore confidence in your body. Over time, most people notice that as they learn to manage their anxiety, the sensations reduce in intensity and frequency. The goal is not to eliminate all sensations, but to respond to them with calm awareness instead of fear.
If you have had a clear cardiac assessment but still experience chest pain, therapy can help you understand and manage these symptoms safely. With the right support, you can regain trust in your body and feel confident that your heart is strong and your mind can be calm.
