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How to tell the difference between angina and anxiety

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Updated on February 2, 2021

Angina and anxiety attacks are separate health events. But there are similarities between experiencing angina and experiencing a panic attack, including chest pain and shortness of breath.

You can learn the differences, but if you have unexplained chest pain, seek immediate medical attention.


When the oxygen-rich blood flow to your heart is reduced, you could feel chest pain known as angina.

This symptom of coronary artery disease with obstruction is most commonly described as feeling like a heavy weight or pressure on your chest. The discomfort is also sometimes described as a fullness or burning.

However, be mindful that the symptoms of angina can be extremely variable and atypical, especially in women or those with diabetes. The way that everyone feels chest pain can be extremely variable.

The most common form of angina is stable angina. Stable angina typically occurs with physical exertion (when the heart’s oxygen demand increases) and goes away with rest (when the heart’s oxygen demand is lower). For example, if you feel chest pain when climbing stairs or shoveling snow, you may be experiencing stable angina.

Other types of angina are unstable angina, microvascular angina, and Prinzmetal’s (or variant) angina. Although the reasons for these types of angina are different, the symptoms that these conditions cause are the same.

Along with chest pain, the symptoms of angina may include:

  • Pain radiating to other areas, such as your jaw, neck, arms, shoulder, or back or stomach
  • Shortness of breath
  • Dizziness
  • Fatigue
  • Sweating
  • Nausea
  • A sense of anxiety, uneasiness, or doom

Anxiety and panic attacks

Anxiety is your mind and body’s reaction to stressful, unfamiliar, or dangerous situations.

Chest pain can also be a symptom of anxiety. It often accompanies a panic attack. A panic attack is an abrupt episode of intense fear with no apparent cause. A panic attack can trigger severe physical reactions. The symptoms of a panic attack may include:

  • Chest pain and shortness of breath
  • Racing heart
  • Dizziness
  • Sweating
  • Sense of impending doom
  • Nausea
  • Chills or hot flashes

How do you tell the difference?

It can be challenging to distinguish between angina and an anxiety attack, especially because emotional distress can also increase the amount of oxygen the heart requires and trigger angina. Angina can occur at rest (unstable angina or Prinzmetal’s angina) or with exertion (stable angina), so it’s very difficult to distinguish the two based on symptoms alone.

Experience can also help differentiate them. If you’ve been diagnosed with either angina or a panic disorder before, you may recognize the discomfort as fitting your diagnosis or what triggers your symptoms.

In the case of chest pain, you should seek medical help right away. Your doctor will run several tests, including an electrocardiogram and a blood test called troponin, to look for signs of heart damage. These tests are the most definitive ways to distinguish the two conditions.

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Treating chest pain caused by anxiety

If you have chest pain caused by anxiety, you have several options.

To treat panic attacks, your doctor may suggest cognitive behavioral therapy. This treatment can help you understand fears or situations that may trigger a panic attack.

You doctor may also recommend medication, such as:

  • SSRIs (selective serotonin reuptake inhibitors) or antidepressants, such as sertraline (Zoloft), paroxetine (Pexeva, Paxil), and fluoxetine (Prozac)
  • SNRIs (serotonin and norepinephrine reuptake inhibitors) or antidepressants, such as venlafaxine (Effexor XR)
  • Benzodiazepines or sedatives, such as clonazepam (Klonopin) and alprazolam (Xanax)

You doctor may also suggest certain lifestyle changes, such as:

  • Learning relaxation and stress management techniques
  • Avoiding alcohol, drugs, smoking, and caffeine
  • Getting enough slee
  • Increasing physical activity

Other causes of chest pain

In addition to angina or anxiety, there are other conditions that can cause chest pain. These include:

  • Narrowing of the heart’s aortic valve (aortic stenosis)
  • Blockage in a lung artery (pulmonary embolism)
  • Tearing of a major artery (aortic dissection)
  • Heart muscle disease (hypertrophic cardiomyopathy)
  • Inflammation in the tissues that surround the heart (pericarditis)
  • Inflammation of the tissue separating your lungs from your chest wall (pleurisy)
  • Lung infection (pneumonia)

They may also include:

  • Spasm of the esophagus
  • Muscular or skeletal pain


Angina is a life threatening condition, while panic attacks, although unpleasant, aren’t life threatening. However, it can be tough to tell the difference between angina and a panic attack without previous experience to compare them to or an assessment by your doctor.

If you’re not sure why you’re experiencing chest pain and other symptoms, seek immediate medical attention.