Coronary Artery Spasms and Anxiety: What’s the Connection?

A coronary artery spasm is a temporary tightening of an artery wall. This tightening constricts blood flow through that artery and causes a type of chest pain called angina, which occurs when the heart doesn’t get adequate blood flow.

Coronary artery spasms may be responsible for about half of all angina cases.

A 2019 population-based study found that coronary artery spasms are uncommon, with just under 0.01% of the general population experiencing one. People over age 50 may have a higher risk of experiencing a coronary artery spasm.

You also have a higher risk if you live with:

• diabetes
• higher LDL (bad) cholesterol
• magnesium deficiency
• chronic inflammation
• high blood pressure (hypertension)

Specific factors that may also trigger a coronary artery spasm include:

• stress
• cold temperatures
• alcohol and alcohol use withdrawal
• hyperventilation
• smoking
• stimulants like cocaine and amphetamines
• medications that constrict blood vessels, including migraine medications and beta-blockers

While coronary artery spasms often cause severe chest pain, they can also occur without symptoms. Sometimes they lead to a condition called cardiac ischemia, which can cause heart attacks.

Both anxiety and depression can increase your likelihood of experiencing a coronary artery spasm. While anxiety is linked to a higher risk, its role in causing coronary artery spasms remains somewhat unclear.

Note

While people with anxiety may have a higher chance of experiencing a coronary artery spasm than the general public, keep in mind it’s still relatively rare to have one. Mild or occasional anxiety may be less likely to trigger coronary artery spasms.

What’s more, anxiety, panic attacks, and stress — sudden, extreme stress as well as chronic stress — can all trigger coronary artery spasms.

Research suggests a few potential reasons stress and anxiety may cause them:

• When anxiety activates the sympathetic nervous system, it can set off a chain reaction in the body that leads to coronary artery spasms.
• Anxiety may increase inflammation and oxidative stress and lead to coronary artery spasms.
• High blood pressure caused by chronic stress may also bring on coronary artery spasms.

Two kinds of coronary artery spasms exist: obstructive, which involves plaque buildup, and non-obstructive, which does not involve plaque buildup.

Anxiety is more strongly linked with non-obstructive chest pain than obstructive pain. In other words, anxiety-induced chest pain doesn’t necessarily mean you have heart disease.

The main symptom of a coronary artery spasm is chest pain. This pain might feel like:

• pressure
• tightness
• squeezing
• fullness

The pain might also radiate, or spread, to other parts of your body like your arms, back, jaw, or neck.

In addition to chest pain, coronary artery spasms might involve:

• nausea or vomiting
• cold sweats
• dizziness or fainting

They often happen when you’re at rest during the middle of the night and early morning, or with exercise first thing in the morning. A coronary artery spasm might last anywhere from several seconds to 15 minutes.

It’s not always easy to tell if you’re experiencing a coronary artery spasm due to anxiety or because of another underlying condition, especially if you live with multiple risk factors.

Learn the major signs of a heart attack.

The pain associated with heart attacks tends to occur in specific regions of the body. It’s best to seek emergency care if you experience severe pain in:

• your jaw, neck, or back
• the middle or left side of your chest
• your arms or shoulders

It’s also a good idea to get medical attention for persistent or severe:

• numbness or tingling in your limbs or face
• irregular heartbeat
• difficulty breathing
• nausea and vomiting
• dizziness and fainting

Just keep in mind that anxiety and panic attacks can also cause these physical symptoms.

Worried about what your chest pain could mean? It may help to consider the following:

• Do you have a history of anxiety or heart attacks?
• Do you live with risk factors of heart attacks?
• Have you had this sort of chest pain before, and has a healthcare professional ever linked it to anxiety?

If you’re under age 30 with no history or risk factors of heart problems, your chances of experiencing a heart attack remain fairly low.

All the same, if you have any doubts over whether your chest pain relates to anxiety or a heart attack, the safest option involves checking in with a doctor or seeking emergency care. When it comes to a potential heart attack, erring on the side of caution could save your life — and it’s OK to be wrong.

If you think your chest pain relates to anxiety, you can take steps to ease it in the moment — and lower your chances of experiencing it again in the future.

What you can do in the moment

These solutions could help you recenter in a moment of intense panic or anxiety:

• Practice deep breathing: Deep breathing, sometimes called belly breathing, may ease chest pain caused by panic because it can help relax your chest muscles and stop hyperventilation, which can make the pain worse.
• Mindfulness: Mindfulness-enhancing exercises, including meditation, progressive muscle relaxation, and mindfulness-based stress reduction, could help you disconnect from thoughts that increase anxiety and chest pain and ground yourself in the present moment, according to a 2017 research review.
• Try mantras: A 2018 review of studies on meditation involving mantras found that mantra meditation helped reduce anxiety and stress for many people who tried it, although more high quality studies are needed to confirm its effectiveness.

Find more anxiety management techniques here.

Long-term solutions

If you know you’re likely to experience anxiety-induced chest pain and you’ve already ruled out potential medical conditions with a doctor, these strategies could help:

• Physical activity: Exercise can help you manage anxiety, and it can also reduce your risk of developing heart disease, which may also help reduce anxiety. Research suggests the increased heart rate and sweating during exercise may also help your body adjust to these feelings, reducing your chances of experiencing a panic spiral due to a higher heart rate.
• Therapy: According to 2015 research, therapy approaches like cognitive behavioral therapy (CBT) could help manage anxiety-induced chest pain.
• Medication: A psychiatrist might recommend medications like selective serotonin reuptake inhibitors (SSRIs) to help treat ongoing anxiety symptoms. They may also recommend a benzodiazepine for short-term use, while waiting for the SSRI to take effect, or occasional treatment of panic attacks. Benzodiazepines typically are not recommended for long-term treatment.

If you regularly experience episodes of chest pain that seem to be linked to anxiety, depression, or stress, therapy could be beneficial. A therapist can help you work on managing emotional symptoms, which could help reduce your pain over time.

If you live with anxiety or have panic attacks, you might experience chest pain as one of a range of physical symptoms — and unexplained chest pain can easily add to your anxiety.

It may help to know that in many cases, chest pain relates to anxiety, not a coronary artery spasm or heart attack. In-the-moment coping skills, like deep breathing and grounding techniques, may help ease feelings of anxiety and soothe physical symptoms like chest pain and nausea.

But when anxiety management techniques don’t seem to relieve chest pain, an irregular heartbeat, or nausea after about 20 minutes, it’s a good idea to get medical attention right away.

Courtney Telloian is a writer with work published on Healthline, Psych Central, and Insider. Previously, she worked on the editorial teams of Psych Central and GoodTherapy. Her areas of interest include holistic approaches to health, especially women’s wellness, and topics centered around mental health.