Stress-related pseudo-angina: understanding the signs

It’s important to understand what triggers this stress-induced chest pain so you can better recognize the signs and take steps to prevent and calm the episode as quickly as possible.

Physiological mechanisms

During intense stress, our body reacts by triggering a chain of reactions. This cascade of physiological responses leads to the symptoms of stress-induced angina. When the brain perceives a stimulus as a threat, it immediately activates the sympathetic nervous system, which is responsible for survival. This activation triggers the release of adrenaline and noradrenaline, two hormones secreted by the adrenal glands. They act directly on the cardiovascular system. They accelerate the heart rate, increase the force of the heart’s contractions, and cause a rise in blood pressure. These changes, intended to prepare the body for action, can be perceived as chest pain or discomfort. At the same time, cortisol, the chronic stress hormone, keeps the body in a state of prolonged alertness. This hormone can affect our sensitivity to pain and amplify unpleasant sensations, such as that feeling of chest tightness. Stress also causes muscle tension, particularly in the intercostal muscles and the diaphragm. These muscle spasms can mechanically create chest pain that mimics the symptoms of angina. This creates a vicious cycle, as the symptoms increase stress, which in turn stimulates cortisol production.

Specific triggers

Acute stress: This is one of the main factors in triggering stress-induced pseudo-angina. Examples include intense workplace conflict, serious family problems, exam periods, a worrying medical diagnosis, or traumatic events. In such situations, the sudden activation of the nervous system can trigger stress-induced angina in just a few minutes.

Chronic stress: this is a major and often underestimated risk factor. Prolonged exposure to stressful situations keeps the body in a state of hypervigilance, which promotes the onset of physical symptoms. People under constant professional pressure, facing long-term relationship difficulties, or going through complicated life stages are particularly at risk.

Anxiety disorders: These are underlying factors but significantly contribute to the onset of stress-induced pseudoangina. People suffering from generalized anxiety, panic disorders, or hypochondria exhibit heightened sensitivity to bodily sensations and a tendency to interpret their body’s signals negatively.

Hormonal factors: particularly in women, hormones play a major role in triggering stress-induced angina. Hormonal fluctuations related to the menstrual cycle, pregnancy, or menopause can influence sensitivity to stress and contribute to the onset of chest tightness symptoms.

Environmental factors: In people prone to claustrophobia, exposure to confined spaces, significant temperature changes, noisy environments, or excessive caffeine consumption can act as triggers for stress-induced angina pectoris.

Genetic factors: In some people, there is a genetic predisposition to anxiety disorders, which creates a favorable environment. Individuals with a family history of panic or anxiety disorders have an increased risk of developing somatic manifestations of stress, including stress-induced chest pain.

Once a doctor has made the diagnosis, it may be easier to implement measures to prevent and manage these episodes. This is especially true when you know the cause is stress and not a heart condition.

1. Practice breathing: If you are prone to stress-induced pseudo-angina attacks, it may be helpful to establish breathing routines to calm your nervous system, particularly the sympathetic nervous system. We recommend diaphragmatic breathing. When practiced regularly, it helps regulate the autonomic nervous system and reduce the intensity of symptoms during attacks. This technique involves breathing slowly and deeply, filling the abdomen rather than the chest, at a rhythm of 4 seconds to inhale, a 4-second pause, and 6 seconds to exhale.

2. Try meditation: Meditation is a recognized practice for helping to develop a different relationship with your body. It allows you to become aware of your bodily sensations and reduce anxiety, which, as we know, is one of the main risk factors that maintains and triggers episodes of stress-induced pseudo-angina.

3. Incorporate herbs into your daily routine: A real boost for coping with stressful or anxiety-inducing events, herbs can be a daily ally. Whether in the form of herbal teas or dietary supplements, herbal medicine can be a significant resource in managing your emotions. They can be used on an as-needed basis during predictable periods of stress (exams, etc.) or long-term to regain control of your emotions. For example, Valerian has numerous benefits. It acts directly on the brain’s GABA receptors, which promotes relaxation and reduces nervous system hyperactivity. Of course, there are other plants that can be used in herbal teas, such as passionflower, hawthorn, or lemon balm. If your emotions are too intense, you can also turn to Ashwagandha, an adaptogenic plant that helps regulate stress and emotions. 

4. Incorporate physical activity: Regular, appropriate physical activity is one of the most effective ways to prevent stress and its physical symptoms. Physical activity releases hormones like endorphins that naturally counteract the effects of stress. This is the case, for example, with walking, a gentle activity that’s easy to incorporate into your routine. About thirty minutes of walking per day is enough to see beneficial effects on our body and nervous system. The same goes for swimming, which has a calming effect due to immersion in water.

5. Prioritize sleep: It is important to maintain a regular sleep schedule with sufficient quality and quantity to allow the nervous system to rest completely and avoid remaining in a constant state of alert. This involves limiting screen time and blue light exposure as bedtime approaches, as these disrupt the production of melatonin, the hormone that regulates the sleep-wake cycle. You can also establish a bedtime ritual, such as drinking a warm beverage like herbal tea.

6. Adjusting your diet: this is a cornerstone of prevention and good health. Prioritize balanced meals rich in anti-inflammatory nutrients, and avoid stimulants like caffeine, theine, or alcohol, which, when consumed in excess, contribute to maintaining an imbalance in the nervous system.

Guillaume is a pharmacy technician specialising in dermocosmetics. With more than ten years’ experience in the pharmacy sector, he now supports health and cosmetics brands with writing blog articles. Having studied naturopathy, he takes part in podcasts to explain health and cosmetics in accessible terms.