Is My Chest Pain a Symptom of Anxiety or COVID-19?

According to a 2017 criterion-standard study involving 965 randomly sampled patients across 15 U.S. primary care clinics, anxiety disorders affected about 1 in 5 participants.

Additionally, early research published in 1999 concluded that about half of study participants from the outpatient psychiatric sample group who were diagnosed with generalized anxiety disorder, per clinical standards, had a history of chest pain.

Generalized anxiety disorder is characterized by excessive worrying about common situations and life events.

When you feel anxious, your body activates its “fight or flight” sympathetic nervous system. This causes changes in your body that lead to symptoms like:

• muscle tightness
• rapid heartbeat
• shaking

Increased tension in the muscles around your chest can cause chest pain and shortness of breath.

Some people with anxiety develop panic attacks. Panic attacks are sudden and intense episodes of anxiety that can onset without warning. They can cause symptoms that mimic a heart attack, such as:

• chest pain
• rapid heart rate
• shortness of breath

The virus that causes COVID-19 is thought to enter your heart, lungs, and other tissues through an enzyme called angiotensin converting enzyme 2 (ACE2). When the virus enters your heart and lungs, it can damage these tissues.

Researchers speculate that COVID-19 chest pain may be caused by injury to the heart or inflammation of your lungs.

Once the virus is in your heart and lungs, it can cause your body to release molecules that promote inflammation called cytokines. These molecules can damage your heart cells by creating an out-of-control immune reaction.

Chest pain is most common in people with severe COVID-19 infection. It’s about three times more common in people who die of the disease than in survivors.

Emergency COVID-19 symptoms

If you experience chest pain or shortness of breath that could be caused by COVID-19, call 911 and go to the nearest emergency room. The CDC also lists the following as emergency symptoms:

• newly developed confusion
• inability to stay awake
• pale gray or blue lips, skin, or nails

People with dark skin may not be able to notice changes in skin or nail color as easily as people with light skin.

Even though both COVID-19 and anxiety can cause chest pain, they’re typically accompanied by different symptoms. Here’s a look at how symptoms of the two conditions typically compare.

Here’s a look at how the other most typical symptoms of anxiety and COVID-19 compare. Symptoms are highly individual, and it’s possible to experience symptoms that are not on this list for either condition.

Chest tightness or pain can be a sign of a serious health condition. It’s a good idea to see a doctor whenever you experience chest pain with an unknown cause. It’s especially important to seek medical help if your pain onsets suddenly or does not respond to anti-inflammatory medications like ibuprofen.

Emergency symptoms

If you experience the following symptoms, or anything else concerning, call 911 or go to the nearest emergency room:

• shortness of breath or trouble breathing
• pain that spreads to your left arm, back, shoulder, or jaw
• confusion
• rapid heartbeat

Treatment for chest pain depends on the underlying cause. Here’s how it’s typically treated when caused by COVID-19 or anxiety.

COVID-19

If you have chest pain or trouble breathing due to COVID-19, you should seek emergency medical attention. COVID-19 does not have a cure, but medical professionals can help manage your symptoms.

People having trouble breathing may be given oxygen or put on a ventilator to assist their breathing. A variety of medications may also be used to manage COVID-19.

• Antiviral drugs. Antiviral drugs such as remdesivir help your body fight off viral infections.
• Monoclonal antibodies. Monoclonal antibodies are proteins that are designed to target the virus that causes COVID-19 and prevent it from entering your cells. The combinations bamlanivimab/etesevimab or casirivimab/imdevimab may be used.
• Anti-inflammatory drugs. Drugs such as the corticosteroid dexamethasone may be given to reduce inflammation caused by COVID-19. Current research suggests dexamethasone has the greatest benefit for people requiring mechanical ventilation.
• Immunomodulators. Drugs such as baricitinib/remdeivir or tocilizumab may be added to your treatment plan. Immunomodulators are a class of drugs that modify the activity of your immune system.

Anxiety

If you experience shortness of breath caused by anxiety, you may benefit from focusing on your breathing. During a panic attack, the National Health Service recommends the following technique:

• breathe in through your nose slowly and as deeply as possible
• exhale through your mouth slowly and gently
• close your eyes and focus your attention on your breathing
• you may find it helpful to count to five each time you inhale or exhale

If a doctor suspects an underlying mental health condition, they may recommend medications, psychotherapy, or lifestyle changes.

COVID-19 and anxiety can both lead to chest pain or tightness. Generally, COVID-19 also causes flu-like symptoms, and chest pain tends to be present continuously. Chest pain and shortness of breath are most common in people with severe illness.

Chest pain caused by anxiety is more likely to onset rapidly. If it’s caused by a panic attack, it will probably go away in less than an hour.

It’s a good idea to seek medical attention whenever you experience chest pain with an unknown cause. Chest pain that onsets suddenly can also be a sign of a serious condition, such as a heart attack.