How to Differentiate Between Anxiety, Intercostal Muscle Spasms, and Heart Attack

Updated on August 9, 2017
Expert ReviewedDr. William H. Frishman, Director of Medicine
montelka profile image

I am a graduate in cell and molecular biology and psychology. I love to write, share ideas, and live a simple life.

Are You Experiencing Chest Discomfort?

People often can't tell if they are having a heart attack or one of many other chest problems. There are two problems that people often confused with a heart attack:

  • Anxiety
  • Strains, cramps, or spasms of the intercostal muscles in the wall of the chest (these are the muscles between the ribs)

This confusion is understandable, as symptoms of these other conditions resemble the symptoms of a heart attack.

Of course, the only surefire way to know is to go to the hospital where different types of diagnostics will be used to evaluate your condition, find out if you had a heart attack and if so, determine how much damage was done. 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 notable differences. Again, if you are in doubt, have had a heart attack before, are elderly, diabetic, or are otherwise at increased risk of a heart attack, you should consult a doctor immediately.

Decoding Chest Pain: Heart Attack vs. Anxiety vs. Muscle Spasms

 
Type of Pain
Timeline
Area
Other Symptoms
Heart Attack
Pressure, tightness, squeezing, or burning; pain is diffuse, not sharp
Onset is gradual and may last for over 30 minutes
Pain can extend to left arm, neck, back, or jaw
Pain or pressure is accompanied by other symptoms, like difficulty breathing, nausea, or cold sweat
Anxiety or Panic Attack
Chest pain that can be sharp and shooting, can feel like muscle spasm or twitching; can take different forms
Can vary person to person — may come and go, be persistent, occur frequently, or occur rarely
Can move around in the chest or affect one area only
Chest pain is common in people with anxiety; may be accompanied by other symptoms of anxiety
Muscle Spasm or Strain
Severe stabbing pain
Sudden onset, lasts for anywhere from five minutes to an hour
Localized pain, usually around the ribs
Usually happens after physical exertion of some kind
Additional sources used: "Chest Pain Anxiety Symptoms" from AnxietyCentre.com and "Chest Pain: A Heart Attack or Something Else" from Harvard Health Publications
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 muscle to die and lose some of its pumping ability. The amount of damage depends on the size of the area that is blocked from receiving blood and how long it takes to get treatment.1

Most heart attacks begin with subtle symptoms that are not usually described as pain — terms commonly used include squeezing or tightness. If you have a very sudden onset of sharp pain, it is likely not a heart attack.

Symptoms of a heart attack include:2

  • Chest discomfort or pain that can feel like a mild ache, pressure, fullness, or squeezing that may last for more than a few minutes and may come and go. This may feel like heartburn.
  • Upper body pain or discomfort that may spread beyond your chest to other parts of your body, like your shoulders, arms, back, neck, teeth, or jaw. You could also just have upper body pain without chest discomfort. These sensations may also feel like numbness, pinching, or prickling
  • Shortness of breath, which usually happens before chest pain (if you have it). You might pant for breath or be unable to take deep breaths.
  • Anxiety and feeling a sense of doom for no apparent reason
  • Irregular heartbeat, or a sudden onset of a racing heart
  • Light-headedness, usually accompanied by headaches
  • Nausea or vomiting
  • Sweating or breaking into a sweat with clammy skin
  • Unusual fatigue

Symptoms of a heart attack last for 30 minutes or longer and don't go away with nitroglycerin under the tongue.1 The symptoms of a heart attack also differ from person to person. If you are over 50, diabetic, or have had a cardiovascular problem before, consult the doctor immediately when in doubt about whether you have had a heart attack.

It is very important to treat heart attacks quickly. If not treated in time, a person having a heart attack may suffer irreversible damage to heart muscles or even die.

Solution: If experiencing heart attack symptoms, get immediate emergency help.

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 may also play a role in reducing risk of heart attack.

Physical Symptoms of Anxiety

Anxiety, stress, and worry can have physical effects on the body.3 When worry becomes excessive, it can trigger a stress response in your body which has two elements. The first involves recognizing the challenge, and the second is an automatic physiological reaction called the "fight or flight response." This response sends adrenaline and other hormones into your body and puts you in a state of high alert.3

The physical symptoms of this heightened state of stress include:

  • Heavy breathing, difficulty breathing through the nose, shortness of breath
  • Constriction of throat muscles, making it hard to swallow saliva, or a sensation of having something stuck in the throat
  • Dry mouth
  • Increased heart beat
  • Confusion, light-headedness, inability to concentrate, irritability
  • 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 it is fading away, skipping, or stopping, when in fact their heart is okay.
  • 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.
  • Muscle aches, muscle tension
  • Nausea
  • Nervous energy
  • Sweating
  • Twitching and trembling

When a person is experiencing strong emotions, like stress or anger, they 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.

Related Condition: Panic Attacks

In a panic attack, the feelings of anxiety can come on quite strongly and suddenly. Panic attacks are sudden feelings of terror that can strike without warning.4 If you're having a panic attack, you may feel like you're going crazy, that you're having a heart attack, or that you are dying.

According to WebMD, you may experience the following symptoms:

  • Feeling a loss of control
  • Breathing difficulties
  • Chest pains
  • Feeling sweaty or having chills
  • Chest pains
  • Sense of terror or impending doom
  • Tingling or numbness in the hands and fingers
  • Feeling weak, faint or dizzy
  • A "racing" heart

These attacks usually only last for around 10 minutes, though some of the symptoms may last for a longer time.

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. If you're experiencing panic attacks frequently, you should see a doctor to find out what kind of solutions are available to you. These may include different kinds of medication.

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

At some point or another, most people experience a muscle spasm or cramp somewhere in their body. A muscle cramp is a sudden and involuntary contraction of a muscle or several muscles.5 Often, muscle cramps happen in the leg muscles — especially the calf — though they can happen anywhere in the body. Though they are usually harmless, they can be quite painful.

Several factors can lead to a muscle cramp, including:5

  • Long periods of exercise or physical labor, especially in hot weather
  • Some types of medication or medical conditions, such as inadequate blood supply or mineral depletion
  • Overuse of a muscle
  • Dehydration
  • Muscle strain
  • Holding a physical position for a prolonged period of time

The intercostal muscles run from rib to rib, and enable a person to breathe by expanding and contracting the chest wall. A spasm can happen 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. They can occur during simple, regular household work as well as more difficult physical labor or exercise.

Symptoms of intercostal muscle spasms include:

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

Solution: Lie flat with arms straightened out above the head to stretch the muscle, or simply wait out the problem. Eventually the spasm will resolve by itself. You should see a doctor if it doesn't resolve itself, if the spasm happens frequently, or if the spasm is not connected to an obvious cause.5

Do You Need to Get Help?

Hopefully this article has helped you understand whether or not what you're experiencing is a medical emergency. Remember that the only way to know for sure if you're having a heart attack is to see a doctor for tests. If you are still unsure or if you are at increased risk for heart problems, please consider seeing a doctor as soon as possible.

Sources Used

  1. Reviewed by James Beckerman, MD, FACC. "Heart Attacks and Heart Disease." April 17, 2017. WebMD. Accessed May 17, 2017.
  2. Mayo Clinic Staff. "Heart Attack Symptoms: Know What's a Medical Emergency." June 25, 2014. Mayo Clinic. Accessed May 17, 2017.
  3. Reviewed by Joseph Goldberg, MD. "How Worrying Affects the Body." August 15, 2015. WebMD. Accessed May 17, 2017.
  4. Reviewed by Joseph Goldberg, MD. "Panic Attack Symptoms." February 9, 2017. WebMD. Accessed May 17, 2017.
  5. Mayo Clinic Staff. "Muscle Cramp." February 16, 2016. Mayo Clinic. Accessed May 17, 2017.
  6. "Chest Pain: A Heart Attack or Something Else." Published May 2010, updated August 11, 2015. Harvard Health Publications. Accessed May 17, 2017.
  7. Folk, Jim and Marilynn Folk, BScN. "Chest Pain Anxiety Symptoms." (n.d.) AnxietyCentre.com. Accessed May 17, 2017.

Expert Review

Dr. William H. Frishman

Director of Medicine
Westchester Medical Center
Valhalla, New York

“This report looks good. My only change would be the type of pain for a muscle spasm or strain. The severe stabbing pain sometimes will worsen by breathing in.”

Comments

    0 of 8192 characters used
    Post Comment

    • profile image

      Melanie 

      11 months ago

      Hi, just thought you could add esophageal spasms to this article - they mimic heart attack and can last for weeks.

    • profile image

      TinaJ 

      14 months ago

      All my symptoms fitted the Heart Attack group.Including numbness of left side of face lips and arm and light headed ness. After going to hospital and having ecg, blood test & chest xray it was determined I had a muscle spasm possibly accompanied by anxiety ( which I don't generally suffer from) I was given a muscle relaxant and sent home. I;m glad I went to get checked though. The hospital staff were very good in Hereford A & E.

    • profile image

      Pete 

      19 months ago

      I have had chest problems 8 months noe had sevral ecg blood tests x rays 2 weeks ago had angiogramme angioplasty they say my pain in chest and over my heart lightening bolt feeling is gerd also heart muscle and chest spasms the pains unreal terryfying have to take omprazole and gtn spray under my tongue when pain starts i live in the uk hospital been brilliant and caring

    • profile image

      Aaron 

      19 months ago

      I have anxiety brought on by a spinal cord/neck injury and a tear in the intercostal muscles. It's good to have a list to lay out the basics between the three because I constantly worry about heart issues and I'm only 29. I've never had one but I get all the symptoms because of the injuries.

    • profile image

      Ann Marie 

      20 months ago

      The explanation which you provider has really helped to reassure me that the pain I experienced last night after a couple of basic yoga moves was nothing more than a muscular spasm. It's just a pity that I didn't read it before Spending 6 hours in hospital having an ECG, chest X-ray etc.!!

    • profile image

      Kathy 

      20 months ago

      I ran a 10km race in which I twisted my ankle and fell. The next day my chest muscles on the right up nearer the shoulder and armpit but on the chest hurt a bit. During the week I washed windows and the next day suffered severe spasms that I cold hardly breath or walk. My husband took me to the hospital where they gave me a small dose of morphine. I no longer get the spasms, but the moment I exert my self using my right arm I feel the pain getting stronger again, but no spasms. How long will it take for this muscle to heal and how can I speed up the process.

    • profile image

      Rowena 

      2 years 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:

    • profile image

      Snakesmum 

      3 years ago

      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.

    • Carol Houle profile image

      Carol Houle 

      3 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.

    • profile image

      Dan 

      5 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!

    • profile image

      Manda 

      5 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 :)

    • profile image

      Chris k 

      5 years ago

      very informative and helpful. Thank you!

    • profile image

      donna 

      6 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/

    • Millionaire Tips profile image

      Shasta Matova 

      6 years ago from USA

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

    • profile image

      riley 

      6 years ago

      Thanks montelka! This helped me a bunch...

    working

    This website uses cookies

    As a user in the EEA, your approval is needed on a few things. To provide a better website experience, healdove.com uses cookies (and other similar technologies) and may collect, process, and share personal data. Please choose which areas of our service you consent to our doing so.

    For more information on managing or withdrawing consents and how we handle data, visit our Privacy Policy at: https://healdove.com/privacy-policy#gdpr

    Show Details
    Necessary
    HubPages Device IDThis is used to identify particular browsers or devices when the access the service, and is used for security reasons.
    LoginThis is necessary to sign in to the HubPages Service.
    Google RecaptchaThis is used to prevent bots and spam. (Privacy Policy)
    AkismetThis is used to detect comment spam. (Privacy Policy)
    HubPages Google AnalyticsThis is used to provide data on traffic to our website, all personally identifyable data is anonymized. (Privacy Policy)
    HubPages Traffic PixelThis is used to collect data on traffic to articles and other pages on our site. Unless you are signed in to a HubPages account, all personally identifiable information is anonymized.
    Amazon Web ServicesThis is a cloud services platform that we used to host our service. (Privacy Policy)
    CloudflareThis is a cloud CDN service that we use to efficiently deliver files required for our service to operate such as javascript, cascading style sheets, images, and videos. (Privacy Policy)
    Google Hosted LibrariesJavascript software libraries such as jQuery are loaded at endpoints on the googleapis.com or gstatic.com domains, for performance and efficiency reasons. (Privacy Policy)
    Features
    Google Custom SearchThis is feature allows you to search the site. (Privacy Policy)
    Google MapsSome articles have Google Maps embedded in them. (Privacy Policy)
    Google ChartsThis is used to display charts and graphs on articles and the author center. (Privacy Policy)
    Google AdSense Host APIThis service allows you to sign up for or associate a Google AdSense account with HubPages, so that you can earn money from ads on your articles. No data is shared unless you engage with this feature. (Privacy Policy)
    Google YouTubeSome articles have YouTube videos embedded in them. (Privacy Policy)
    VimeoSome articles have Vimeo videos embedded in them. (Privacy Policy)
    PaypalThis is used for a registered author who enrolls in the HubPages Earnings program and requests to be paid via PayPal. No data is shared with Paypal unless you engage with this feature. (Privacy Policy)
    Facebook LoginYou can use this to streamline signing up for, or signing in to your Hubpages account. No data is shared with Facebook unless you engage with this feature. (Privacy Policy)
    MavenThis supports the Maven widget and search functionality. (Privacy Policy)
    Marketing
    Google AdSenseThis is an ad network. (Privacy Policy)
    Google DoubleClickGoogle provides ad serving technology and runs an ad network. (Privacy Policy)
    Index ExchangeThis is an ad network. (Privacy Policy)
    SovrnThis is an ad network. (Privacy Policy)
    Facebook AdsThis is an ad network. (Privacy Policy)
    Amazon Unified Ad MarketplaceThis is an ad network. (Privacy Policy)
    AppNexusThis is an ad network. (Privacy Policy)
    OpenxThis is an ad network. (Privacy Policy)
    Rubicon ProjectThis is an ad network. (Privacy Policy)
    TripleLiftThis is an ad network. (Privacy Policy)
    Say MediaWe partner with Say Media to deliver ad campaigns on our sites. (Privacy Policy)
    Remarketing PixelsWe may use remarketing pixels from advertising networks such as Google AdWords, Bing Ads, and Facebook in order to advertise the HubPages Service to people that have visited our sites.
    Conversion Tracking PixelsWe may use conversion tracking pixels from advertising networks such as Google AdWords, Bing Ads, and Facebook in order to identify when an advertisement has successfully resulted in the desired action, such as signing up for the HubPages Service or publishing an article on the HubPages Service.
    Statistics
    Author Google AnalyticsThis is used to provide traffic data and reports to the authors of articles on the HubPages Service. (Privacy Policy)
    ComscoreComScore is a media measurement and analytics company providing marketing data and analytics to enterprises, media and advertising agencies, and publishers. Non-consent will result in ComScore only processing obfuscated personal data. (Privacy Policy)
    Amazon Tracking PixelSome articles display amazon products as part of the Amazon Affiliate program, this pixel provides traffic statistics for those products (Privacy Policy)