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Chest pain is a frightening experience that sends many people to the emergency room. Nearly half of them learn they don’t have a heart problem. Of those, 30-40% discover that anxiety was the culprit.

In short, anxiety and chest pain share a close relationship, but that doesn’t mean you can assume anxiety is to blame. You can’t risk delaying medical attention when there’s a chance you have a heart condition or you’re having a heart attack.

If you suspect you’re having a heart attack, call 911. Otherwise, Laura Fernandes, MD, FACC, at Woodlands Heart and Vascular Institute can run diagnostics in the office to rapidly determine if you have cardiovascular disease.

Learn how anxiety causes chest pain and if it’s possible to tell the difference between anxiety and heart-related symptoms.

Anxiety is your body’s natural reaction to a threat, whether the threat is immediate or in the future. Any time you feel anxious, your brain automatically sends out hormones that activate the fight-or-flight response.

Whether you’re stuck in traffic, worried about a job interview, or face a threatening situation, your brain’s natural reaction energizes your body so you can deal with the threat or quickly react and escape the situation.

When you’re anxious, your brain sends a surge of adrenaline and cortisol through your body. These hormones immediately trigger a rapid rise in your heart rate and blood pressure. As a result, many people experience chest pain and sweating, or have a hard time breathing.

The sudden boost of adrenaline can narrow the arteries in your heart and attach to cells inside the heart. This condition, called stress cardiomyopathy, mimics a heart attack, from symptoms all the way down to changes in your heart’s electrical activity.

Though stress cardiomyopathy usually heals within a few days or weeks, it may lead to weak heart muscles, congestive heart failure, and abnormal heart rhythms.

Levels of adrenaline and cortisol don’t return to normal in people with anxiety disorders such as generalized anxiety disorder, panic disorder, and post-traumatic stress disorder. Chronically high hormone levels may trigger a panic attack (causing symptoms that feel like a heart attack) and increase your risk of cardiovascular disease.

It’s hard, if not impossible, to tell the difference between anxiety-induced chest pain and the pain caused by an underlying heart condition. In addition to your chest pain, both can cause:

Everyone experiences slightly different symptoms, whether they have anxiety or a heart problem. For this reason, the following two qualities aren’t written in stone. However, they’re generally true and may help you determine the cause of your chest pain:

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