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Is stress causing my chest pain?

1) Dear Alice,

For the past year now, I have been getting sharp chest pains. Sometimes it feels like I am about to have a heart attack. I find it painful to breathe for the couple of seconds that it happens. The sharp pains occur mostly in the lung/heart area. However, I have also felt them in the lower chest area as well. I don't know what is causing this.

Also, it occurs most frequently during the school year. I should also note that during the school year, I tend to eat greasy fatty foods. However, I had my cholesterol level checked (95) which is low. These pains come any time of day, while I am sleeping, walking, sitting, etc. I am 21-year-old female, if that helps.

By the way, I have a doctor's appointment back home later this month. But I want to have an idea why this happening. Others mentioned to me things about stress, something about a dog's heart, and I was even thinking that it might be cancer.

Signed,
Worried

2) Dear Alice,

I've recently been experiencing chest pains in the sternum area. Although I don't believe it is related to heart trouble, I think the pain is originating from the bones or muscles attached to the sternum. I have seen doctors but most are clueless as to where the pain may be specifically originating. An interesting side is that during times of stress, the pain is more severe and concentrated at specific points along the sternum. One hypothesis is that the pain may be related to an injured sterno-manubrial joint. If indeed this is the case, what therapy is available to a poor, uninsured student? My mental health is being affected since my once pumped-up, rock hard body is slowly atrophying since I can't lift weights without extreme pain. I'm depressed because the size of my chest is now smaller. What do I do? What's wrong with me?

Sincerely,
Bird-chest in pain

Dear Worried and Bird-chest in pain, 

What a pain in the chest! When it comes to chest pain, there are many potential causes, and some factors such as lifestyle, genetics, or environmental determinants that may contribute to them. The concerns you bring up, such as stress, muscle, joint, or bone injury (such as the manubriosternal joint), or other conditions could possibly be the reason. That said, the causes for chest pain can be vast and therefore the range of treatments is just as broad since each treatment corresponds with the underlying cause of pain. When it comes to seeking treatment, many health care providers and mental health professionals have sliding scales or payment plans to help those who may not have insurance. 

Unfortunately, chest pain isn’t straight forward. It may help to talk with a health care provider about what you’re experiencing, to begin to identify the cause. Depending on the cause, the pain can be characterized in many different ways, including: 

  • Cardiac (heart related): caused by physical effort, strong emotion, or eating 
  • Pleural (related to the space surrounding the lungs): associated with coughing or pain while breathing 
  • Gastrointestinal, esophageal, or peptic ulcer: burning sensation, common at night or when laying down 
  • Arthritis: local, tender, pain from movement 
  • Cervical (related to neck): often due to injury, worse with physical activity or movement 
  • Musculoskeletal: worse with physical activity or movement such as twisting and bending 
  • Psychoneurotic: related to anxiety 

While looking at the characteristics may be helpful, it may also be useful to identify reasons for chest pain. Some of these may be conditions themselves, while other times the chest pain may be a symptom of something else like: 

  • Heart conditions. Angina, heart attack, and pericarditis may all cause chest pain. Angina happens when blood has trouble flowing to the heart, and when the artery is fully blocked, a heart attack may happen. Pericarditis is the inflammation that occurs around the heart. 
  • Esophagitis. This is inflammation of the esophagus, the organ that connects the throat to the stomach. 
  • Gastroesophageal reflux disease (GERD). This condition is when someone experiences stomach acid going back up the esophagus (also called acid reflux) repeatedly. Acid reflux can cause heartburn. 
  • Anxiety or panic disorders. Experiencing anxiety or panic may lead to chest pain, rapid heartbeats and breathing, or feeling short of breath, among other non-chest related symptoms. 
  • Stress. Both physical and emotional stress may cause chest pain. The inflammation that occurs from stress may disrupt your normal bodily functions. 
  • Costochondritis. This condition is characterized by pain in the chest due to inflammation of the cartilage between the ribs and sternum. 
  • Pulmonary embolism (PE). PE may cause a shortness of breath and chest pain that can affect people at any age, especially if they smoke or take birth control. 

Some lifestyle factors may contribute to the conditions that cause this pain. Heartburn or esophagitis may be worsened by eating fatty meals, smoking, alcohol, or caffeine. Additionally, reducing stress may also help to reduce chest pain. 

As for the question about cancer: chest pain can be a symptom of some cancers, but it usually isn’t the only symptom. Additionally, some people with cancer have weakened immune systems, so they may be more likely to be susceptible to other illnesses that may cause chest pain. 

Treatment options for what you’re experiencing will vary based on the reason for the pain. You both mentioned speaking to a health care provider soon or in the past, which is a great start. If you decide to talk about your chest pain, describing your symptoms, what makes the pain better or worse, and what you’ve already tried may be useful in helping them to pinpoint the cause. Depending on the culprit of chest pain, they may prescribe medications, order additional tests, or recommend lifestyle changes to alleviate the pain. Additionally, you may need to seek multiple opinions since many specialists focus on just their designated area of the body. Check out the Communicating and Relating fact sheet for more strategies on how to state your concerns. Regardless, it’s wise to always get chest pain checked out as soon as possible to make sure that it isn’t due to something life-threatening.  

Take care, 

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Last updated Feb 16, 2024
Originally published Oct 01, 1993