Anxiety in the body: pain in the region of the heart

ANXIETY IN THE BODY: PAIN IN THE REGION OF THE HEART
Anxiety frequently produces pain in the left side of the chest which we immediately suspect to be due to some disease of the heart. However, the pain of anxiety is usually situated well to the left side in the area where we can normally feel the heart beat. On the other hand the pain from organic disease of the heart is situated more centrally, under the breast bone. Furthermore, we experience heart pain due to anxiety at any time, even lying down and resting, while organic cardiac pain is typically brought on by physical effort and stops when we rest. Organic cardiac pain also tends to radiate down the left arm in a way which does not usually occur when the pain is of functional origin.
Only a few days ago a doctor brought his twenty-two-year-old son to me. He was a big lad of fine physique and was a successful athlete. In a pleasant extrovert manner he told me that for the past five months he had had continuous pain over his heart and down his left arm. The pain had come on when he was under a lot of stress studying for exams at a time when his girl friend was also demanding his attention, and he felt he could not cope with both. He had recently seen a cardiologist who found him normal and who had suggested a visit to me.
I have mentioned that pain over the heart due to anxiety rarely extends down the left arm. This lad was convinced that there was something wrong with his heart. He is the son of a doctor; and when I questioned him, he said that he knew quite well that pain from heart disease goes down the left arm. This serves to illustrate the way in which the symptoms of anxiety can be modified by our knowledge of our body and its functions.

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