# Grief‐Related Chest Pain: A Review, Conceptual Analysis, and Integrative Model

## TL;DR

This paper explores how grief can cause chest pain by analyzing its physiological and psychological mechanisms and proposes a model to better understand and address this under-researched symptom.

## Contribution

The paper introduces a novel theoretical model linking grief to chest pain through psychoneuroimmunological mechanisms.

## Key findings

- Only four empirical studies specifically examined grief-related chest pain without addressing physiological mechanisms.
- The proposed model integrates autonomic, immune, and neuroendocrine pathways in explaining grief-related chest pain.
- Chest pain during grief may serve an evolutionary function by signaling threat and promoting care-seeking behaviors.

## Abstract

Although the death of a loved one is a ubiquitous experience with chest pain a commonly reported symptom, grief‐related chest pain and particularly its physiological mechanisms remain under‐investigated. To address this gap, we adopted Rodger's approach to concept analysis to explore the psychoneuroimmunological mechanisms potentially linking bereavement to chest pain and subsequent health outcomes. A PubMed search, followed by a systematic review of existing literature and clinical observations, yielded 220 articles, of which 49 were included in the conceptual analysis. Notably, only four empirical studies specifically examined grief‐related chest pain, but without underlying physiological mechanisms, while 45 studies explored psychoneuroimmune processes more broadly in the context of loss, grief, and bereavement. Based on these findings, we propose a theoretical model of grief‐related chest pain. The model integrates insights from studies on autonomic, hemodynamic, musculoskeletal, respiratory, neuroendocrine, and immune changes during grief. It summarizes antecedents, attributes, and consequences of grief‐related chest pain, highlighting the putative interrelated roles of physiological, neuroendocrine, and immune pathways. Our model suggests that grief‐related chest pain may constitute a key physical symptom of grief, arising from physiological responses to acute emotional distress and loss. A deeper understanding of the psychobiological mechanisms underlying this phenomenon may provide prognostic insights, inform disease prevention, improve patient care, and guide the development of targeted interventions. Building on this perspective, we also propose a toolkit to facilitate the assessment of grief‐related chest pain in future empirical studies.

We propose that stress‐induced dysregulation of the autonomic, immune, and neuroendocrine systems may contribute to hemodynamic and respiratory changes, potentially leading to grief‐related chest pain, a common yet underexplored physical symptom of grief following the death of a loved one. Given the vital role of the cardiovascular and respiratory systems in the chest, we suggest that chest pain serves an evolutionary function, signaling a perceived threat and promoting care‐seeking behaviors to enhance survival during vulnerable and distressing periods.