Differentiate Between Anxiety, Intercostal Muscle Spasms, and Heart Attack

Experiencing Chest Discomfort?

Often, people don't know if they are having a heart attack or one of many other chest problems. The problems most commonly confused with a heart attack are 1) anxiety and 2) strain, cramp or spasm of the intercostal muscles in the wall of the chest. This confusion is understandable, as symptoms of these two conditions resemble the symptoms of a heart attack.

Of course, the way to tell the difference for sure is to see a doctor. A doctor can run an electrocardiogram (ECG), which checks for abnormalities in the beating of the heart. Nevertheless, there is not always a hospital close by, and knowing the symptoms of these three conditions can help you prepare for whatever may follow.

Although symptoms of anxiety and intercostal muscle spasms closely resemble those of a heart attack, there are differences. Again, if you are in doubt, consult a doctor immediately.

Symptoms Compared

Intercostal Muscle Spasm
Heart Attack
Chest Pain
May be present, caused by heavy breathing; gets worse with breathing
Severe pain localized in the lower chest; gets worse with breathing or movement
May be severe; may radiate to different parts of upper body from the chest; may feel like "squeezing"
Difficulty Breathing
Breathing is heavy
Heavy breathing causes pain
Possibly gasping, due to difficulty getting oxygen into bloodstream
May increase if anxiety is present
May be irregular or racing

Physical Symptoms of Anxiety

Anxiety is commonly associated with fear. The body goes into an alarmed state, what is called a fight-or-flight state. A person experiencing strong emotions, like stress or anger, may well focus on their thoughts or on their surroundings, rather than on how they are feeling physically. When a person finally pays attention to their bodily sensations, these sensations may seem to have started suddenly, when in fact they have been going on all day, along with the unpleasant thoughts that cause them.

Physical symptoms of anxiety include:

  1. Heavy breathing, or difficulty breathing through the nose
  2. Constriction of throat muscles, making it hard to swallow saliva, or a sensation of having something stuck in the throat
  3. Increased heart beat
  4. Confusion and light-headedness
  5. Heightened senses. A person may become extremely sensitive to sound, touch, taste, or anything that happens in the body. A person may become unduly concerned about these sensations. The most common example is a person listening to their own heart beat, and getting the sense that their heartbeat is fading away, skipping, or stopping, when in fact their heart is okay.
  6. Chest pain, especially towards the ribs or sternum (middle of the chest). This is usually caused by the heavy breathing. The pain increases when inhaling or exhaling.

Solution: There are many solutions, mostly involving relaxation techniques (e.g. meditation) or distraction (e.g. exercise, talking to a friend). If anxiety often causes physical symptoms, counseling or therapy may lead to a long-term solution.

The Intercostal Muscles

Intercostal muscles go from rib to rib.
Intercostal muscles go from rib to rib. | Source

Symptoms of Intercostal Muscle Strain or Spasm

Almost everyone has experienced spasms like these, and when they do, many wonder if they are having a heart attack. Having frightening thoughts may cause anxiety, making the problem feel worse.

The intercostal muscles run from rib to rib, and enable a person to breathe by expanding and contracting the chest wall. A spasm happens when a person constricts their lower chest muscles for a long time and then suddenly extends the same muscles. For example, a spasm can happen when a person bends or hunches forward for some time and then suddenly straightens their upper body. A spasm can also be caused by lifting heavy objects or abruptly twisting the body.

Symptoms of intercostal muscle spasms include:

  1. Severe stabbing pain in the lower left or right chest, that persists. Usually worsens with an attempt to move or straighten the upper body
  2. The pain is is localized at one single point, usually around the ribs or in the middle lower area of the chest
  3. If the person is not anxious, the heart beat is usually steady.
  4. Pain increases with heavy breathing
  5. Pain may last from five minutes to an hour or more

Solution: Lie flat with arms straightened out above the head, or simply wait out the problem. Eventually the spasm will resolve by itself.

Anatomy of the Lungs and Heart (detail), Quain's Plates
Anatomy of the Lungs and Heart (detail), Quain's Plates | Source

Symptoms of a Heart Attack

A heart attack can be caused by multiple factors related to poor cardiovascular health, or by trauma, electric shock, or infection. An attack occurs when the blood supply to the heart muscle is impaired, usually by a clot in a blood vessel, causing the heart to lose some of its pumping ability. This can cause confusion in the heart rhythms, leading to a cardiac arrest.

If not treated in a few minutes, a person having a heart attack may die, or suffer irreversible damage to heart muscles.

Although perhaps a quarter of heart attacks produce no symptoms at all, in most cases a heart attack is accompanied by unbearable or overwhelming pain in the chest, followed by very serious consequences within a short time.

If you are over 50, or have had a cardiovascular problem before, consult the doctor immediately when in doubt about whether you have had, or are at risk for, a heart attack.

Symptoms of a heart attack include:

  1. Mild to severe bursts of pain in the chest, often on the left side, which spread to other areas of the chest, shoulders, jaw, back, or abdomen: that is, in a lightning-streak pattern. Some describe the pain as "squeezing."
  2. Inability to breathe, or to breathe deeply; gasping
  3. Irregular heartbeat, or a sudden onset of a racing heart
  4. Light-headedness, usually accompanied by headaches
  5. Stiffness and numbness of the shoulders and jaw area
  6. Nausea or vomiting

Solution: If experiencing heart attack symptoms, call for help (in North America, dial 911) or contact a doctor IMMEDIATELY. Blood-thinning drugs or surgery can preserve heart function.

In the long term, lifestyle changes can reduce symptoms of heart disease and make further attacks less likely: eating a healthy diet, exercising, and avoiding risky habits such as excessive smoking or drinking. Medications, for example blood-thinning medications, may be prescribed.

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Comments 9 comments

riley 5 years ago

Thanks montelka! This helped me a bunch...

Millionaire Tips profile image

Millionaire Tips 4 years ago from USA

This is very helpful to be able to tell the difference between these three conditions. Thank you.

donna 4 years ago

my daughter went to hospital with chest pain and burning in throut also pain in left elbow 2 blood test said she had a heart atack she has had 3 in 3 days what's happening/

Chris k 4 years ago

very informative and helpful. Thank you!

Manda 3 years ago

I know this is a little older but thanks for posting! I looked up "intercostal muscle spasm" after being hunched over sitting and standing straight up and getting a pain from my lower floating rib up to and throughout my breast, which was worse when I took breaths. Your page was the first thing that came up! So thank you for the confirmation that that was all that happened :)

Dan 3 years ago

Thank you for this. I have scoured the internet for information on this and I feel that it is something that doctors would almost never diagnose. Having suffered from anxiety and recently having similar recurring symptoms without the triggers it occurred to me that there must be another explanation and now that I am aware of this injury it seems to have vanished! I am astonished and am laughing as I type this. It was like being made aware of it...well made it go away. It has been plaguing me for weeks or months on and off but now I know its just a muscle thing the anxiety phantom symptoms are gone and not compounding the muscular tension. Amazing...thankyou!

Carol Houle profile image

Carol Houle 2 years ago from Montreal

Very good separation of these symptoms. Thanks. I've taken note of spastic pain in the chest, and stiffness and numbness.

With atrial fibrillation, some of these same symptoms occur, so sadly, I am forever worried.

If one also has the sharp pain of sternum inflammation 1 or 2 days after heavy lifting or moving, you will find that it does recur each time one does heavy lifting. I've had it for longer than Michael Jackson had it.

Snakesmum profile image

Snakesmum 16 months ago from Victoria, Australia

It is difficult to distinguish between heart attacks and other problems. On one occasion I was taken to hospital with a suspected heart attack, but it turned out to be acute indigestion! Lucky for me. The symptoms were exactly the same.

Rowena 7 months ago

Thanks for this article. Just used it to convince my partner that I am NOT hsving a heart attack but a muscle spasm. He still made me a cup of tea. c:

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