Is the chest pain I've been experiencing directly related to stress and anxiety? If so, how can I alleviate some of the discomfort and put my mind at ease?

December 28, 2009 7:20 AM

Is the chest pain I've been experiencing directly related to stress and anxiety? If so, how can I alleviate some of the discomfort and put my mind at ease?

For the past 3 or 4 months I've been experiencing sharp pains in the middle/left of my chest. These pains often come without warning, last for for a few seconds to several minutes, and are sometimes accompanied by numbness and moderate pain in my left arm.

For several weeks I feared the worst. About a month ago I had a VERY jarring, sudden tugging sensation and sharp pain in the middle of my chest. I went to the emergency room and had an EKG, x-ray, blood work, etc. The doctor ruled out a heart problem based on the test results, but wouldn't give a firm diagnosis based on the numerous possible causes.

I'm 33 years-old and quit smoking immediately after my hospital visit. I am in reasonably good shape and maintain an average diet. The chest pains subsided for a while, but have recently returned. Every time I experience this I have a gripping fear that I'm experiencing a heart attack or have some kind of serious heart condition.

I have been under quit a bit of stress over the past several months (pregnant wife, birth of first child, promotion at work, studying for a course) and am somewhat convinced that this may be where the problem lies. I never seem to realize that I'm under stress until I reflect on it when I'm more relaxed months later. Am I OK? What are some tried and true methods by which to relieve anxiety?

posted by Tenacious.Me.Tokyo to Health & Fitness (19 answers total)

You can try breathing exercises, or if you go talk to a doctor about your stress, they might prescribe you a mild sedative for panic attacks (there's a pretty good chance that your doctor will want you to see some sort of mental health professional if you go this route, fyi).
posted by oinopaponton at 7:30 AM on December 28, 2009

I t could be related to stress, it could be something else. We can't tell you. Go see your family doctor about it, and make sure he's got your ER records to review.
posted by amro at 7:30 AM on December 28, 2009

Stating the obvious: you need to see a doctor, more than just the ER or walk-in. The doctor will possibly do a stress (treadmill) test, or give you a Holter monitor to try and see what's going on.

Even if it is stress-related (which I experienced myself, so I know how painful and distressing it can be) it can still be dangerous. Many people use the phrase "it's just stress" but stress can be very serious, causing physical damage to the heart, over-production of adrelaline, high blood pressure, and many other problems.

Put yourself under a doctor's care.
posted by The Deej at 7:31 AM on December 28, 2009

It does not sound like your physical condition has been adequately diagnosed. It is very unlikely that you have a heart problem. You're 33, which makes you almost categorically ineligable for most conditions which develop with age, and you're starting to get a little old for a congenital defect to present itself.

Still, ACHD--adult congenital heart disease--isn't something most emergency physicians are trained to diagnose. The fact that you had a normal rhythm when you went to the ER rules out a heart attack, but there are quite a number of defects which do not produce consistently abnormal rhythms. Consider getting yourself worked up by a cardiologist.

With that in mind, it still may not be cardiac. In fact, it probably isn't. Atrial septal defects, the most common congenital defect observed in adults, are detected in less than 1/10 of 1% of live births. You might consider seeking counseling. Stress can cause physical symptoms if not dealt with properly, and as your systems appear to be neither very serious nor very regular, that sounds like as plausible a situation as any.

IANAD.
posted by valkyryn at 7:33 AM on December 28, 2009

We don't know if you are OK, hopefully you are,

as to what relieves anxiety... well there are a wide range of options: exercise, meditation, medication, being the top three. Trick is you can't just do one or the other for a week or two and be all better, they all pretty much require long term commitments. A lot of people will try and steer you away from the medication, and in general I agree with that steering, but it is an option.

Franklly, I'd make an appointment with your GP and keep going back until they can give you a good answer as to what is happening. Sounds scary.
posted by edgeways at 7:33 AM on December 28, 2009

I've had a similar problem, although I've never thought it was a heart attack. I find it usually happens when I'm under stress, and I end up dwelling on certain negative events. In the short term, you might want to see a doctor and get a benzodiazapine prescription. They help, although they're not a long-term solution. It also sounds like some therapy might help. Congnitive behavioral therapy helps you identify thought patterns that can set off attacks like this, so that's something else you might want to look into.
posted by dortmunder at 7:34 AM on December 28, 2009

Best answer: Well, it's certainly possible that it's stress and anxiety causing this chest pain. I (femal here) had chest pains like that (but no arm numbness) and it was anxiety (according to a medical professional). I had an EKG, too, just to rule out any heart problems, and when that showed nothing, the PA asked me what'd been going on in my life--well, I'd just returned from the longest business trip I'd taken since the birth of my preemie daughter. That about summed it up. Although I was fine on the outside, having fun on the trip and not really missing my normal mommy routine, I wasn't fine on the inside, and this was my body's way of telling me that. Turns out my mom had anxiety and chest pains when she returned to work after having babies, too, so I chalked it up to genetics.

The long-term problem is that anxiety and stress can damage your vascular system (through higher blood pressures which are undetected, for example). So getting your anxiety or stress under control is definitely key, not only to stop worrying and having chest pain, but also for your overall health. For this, I'd suggest two visits: first, to a cardiologist to make sure you really don't have anything wrong with your heart. Since you didn't get a diagnosis from the ER doctor, follow-up with a cardiologist is prudent. Next, I would recommend going in to see a counselor of some type, for help with coping methods for stress. A good counselor, upon hearing your story, will let you know if you need another level of help (like a psychologist or psychiatrist). Start with your EAP (employer assistance program) if you have one.

What else has helped my stress and anxiety? Talking or venting with other parents. Getting enough sleep. Re-evaluating my level of expectation (for instance, it's OK if the house isn't cleaned perfectly every weekend, or if that load of laundry sits there for another day). Going on walks (babies and dogs are excellent walking companions). Giving myself permission to zone out (for me, that means reading a book or watching an hour-long TV show--that's a big luxury). I also have an excellent, supporting, loving husband and a great sister who do not judge me and are able to give me a respite when I need it. I don't take medication other than a very occasional tranquilizer--but I know that antidepressants are commonly prescribed for anxiety disorders. (This is not saying that you have a disorder, or are acting any other way than normal.)

Parenting is the hardest thing I've ever done. Knowing your limits is a very mature and wise thing. Good luck (and congratulations on all of the awesomeness in your life).
posted by FergieBelle at 7:42 AM on December 28, 2009

I had the same thing and, after taking measures to reduce my stress, haven't experienced those pains again. The worst part of it for me was trying not to panic when I was laying on the floor with crushing chest pain, even though my doctor ruled out gallstones and heart issues.
posted by theraflu at 7:52 AM on December 28, 2009

Go to a cardiologist. Really.
posted by jennyjenny at 7:57 AM on December 28, 2009

The ER doc was a bozo. Numbness or pain in the left arm is a dead giveaway to any boyscout with a First Aid merit badge - that's a heart condition acting up. You need to see a cardiologist before one of these episodes turns into a full-blown heart attack.

While stress can exacerbate a heart condition, treating the stress without diagnosing and controlling the condition, is not the way to go here.

Also, heart disease is not necessarily caused by age or lifestyle - it could simply be something congenital. You need to see a specialist, and whine at your GP until he/she refers you to one.
posted by Slap*Happy at 8:00 AM on December 28, 2009

Ignore all advice other than seeing an MD in an outpatient setting to help narrow down the problem. You said

The doctor ruled out a heart problem based on the test results, but wouldn't give a firm diagnosis based on the numerous possible causes.

And they were right; there are a lot of other possible causes. It could be scary something something above; it could be acid reflux; it could be anxiety or stress. I cope with anxiety by thoroughly and consciously evaluating where I am and making a commitment. I cope with stress by finding accomplish-able finish-able things in the sea of shit to do.
posted by a robot made out of meat at 8:03 AM on December 28, 2009

I had a similar experience a few years ago, and was diagnosed with costochondritis. Once I knew it wasn't serious, the anxiety abated, and with it, the pain. It's definitely worth visiting a doctor to see if they can more definitively diagnose you. Good luck.
posted by judith at 8:22 AM on December 28, 2009

I would get the proper checkup, and then if you're cleared for heart problems, you might ask for a referral to...whoever would be best to see for shoulder/arm RSI issues. I don't even know if that's conventionally orthopedic or neurology anymore, but your doctor should be able to steer you in the right direction. If both doctors clear you for it, consider yoga (you can start with DVDs or even YouTube to dip your toe in the water) to help with stress and loosening up the muscles in your arms and upper body.

You might also look into replacing your pillows and taking stock of your sleep positions. But doctor first.
posted by Lyn Never at 8:25 AM on December 28, 2009

I had chest pain a few years ago (when I was 29) and it turned out to be a virus. I thought I was having a heart attack.
posted by cowmix at 10:17 AM on December 28, 2009

I see this hasn't been brought up yet, but some chest pains are sometimes due to ribs or calcification near the ribs rubbing a nerve ending... I had a family member that went to the ER for chest pain 10 years ago and wore an EKG recorder for days, and that was the diagnosis; the symptoms disappeared after a month. So if the pain feels kind of shallow, that could be what it is... sharp chest pains are also sometimes due to bronchial causes, particularly if they have synchronicity with breathing cycles. In any case, agree on getting thee to a doctor.
posted by crapmatic at 10:18 AM on December 28, 2009

I had the exact thing happen to me exactly a year ago now, ER visit turned out the same too.

I think it came on due to holiday driving -- a thousand miles in under a week, with nearly all of it with only my left arm and shoulder.
posted by tad at 10:24 AM on December 28, 2009

Best answer: Here's a list of symptoms that can be caused by anxiety.

First step would be to follow up with your regular doctor and see if he or she thinks a referral to a cardiologist is necessary. I had a full cardiology workup, including an echocardiogram and stress test, and was sent away with a clean bill of health. Also, see if your doc thinks a psychiatric referral is warranted.

Notice what you are doing, pay attention to your body. Are you clenching up? Holding your breath? Gritting your teeth? Are you getting enough sleep? I had a time when I was working full time at a stressful job, going to school at night, plus dealing with an unsupportive husband and raising a 6 year old. Then a relative came down with a terminal illness. I ended up quitting the night course and then quitting the job and going into less stressful work. During the most stressful period, my doc gave me a short term prescription for Valium. One old fashioned device is a worry stone, just keep it in your pocket and give it a rub when you're feeling anxious.

Exercise is numero uno for anxiety. Park your car further away when you go to the store, take the stairs, walk around the block, do jumping jacks, etc. (after you get cleared by your doc, of course). Next, deep breathing, look up yoga breathing. Watch funny shows and stay away from the news when you're feeling stressed. Have lower expectations of yourself in areas of your life that don't matter (i.e., you can do the dishes the next morning, the bed doesn't have to have hospital corners, things like that). I've also had luck with self-hypnosis CD's, listening to music, and aromatherapy, but really, exercise is the best.
posted by Marie Mon Dieu at 10:34 AM on December 28, 2009

Two people I know experienced very similar symptoms and in both cases the final determination of the cause was that they were having panic attacks. I think you need to be following these symptoms up with a doctor and making sure you eliminate the possibilities of serious medical concerns. But I will be honest, the similarity of the course of symptoms and reactions you describe is uncanny and I think you should keep the possibility of acute anxiety as the primary problem in the mix because given your self-description the possibility that you are experiencing a genuine life-threatening heart disorder is very, very small. But even if it is anxiety-based you should not be ignoring this or relying purely on addressing it with DIY methods.

Both individuals I knew required treatment to resolve their issues. Feel free to contact me offline if you want to talk about what was related to me in detail (one of the individuals in particular is very close to me and I heard about and was involved with their experiences in great detail).
posted by nanojath at 10:37 AM on December 28, 2009

Tai Chi and bike riding really alleviated my stress related anxiety years ago. I think it's the deep breathing that really helps. It's amazing how many days can go by without taking a truly deep breath. On the days you do not exercise try to make a point to take a really deep breath at least a couple of times a day, it makes a difference.
posted by any major dude at 11:18 AM on December 28, 2009