Heart palpitations and anxiety: here's what they are and what connects them

By Cristiano Antonino On Apr 14, 2023

Palpitations, chest pain: a heart problem or the onset of an anxiety attack? It’s the 44th minute of the Juventus – Sporting Lisbon Champions League match and Juventus goalkeeper Wojciech Szczesny is asking for a replacement

He complains of chest pain, breathing difficulties, palpitations: he goes out in tears, comforted by his teammates and opponents, to make room for a Perin protagonist of great saves.

At the end of the game Szczesny will appear in front of the cameras (together with his colleague and friend Perin) to explain that from a cardiac point of view everything was ok: “I was scared, it had never happened to me”.

Anxiety, this seems to have been the case, is a problem that is far from trivial and more widespread than one might imagine

And in this picture heart palpitations play an important role, which reinforces the bad feeling of the imminence of an anxiety attack.

It is therefore appropriate to talk about it seriously, on a medical health level.

What are anxiety heart palpitations?

Heart palpitations feel like your heart pounds, flutters, races or skips a beat. When you have a palpitation, you may feel your heart beating in your chest, neck or throat.

Many people experience heart palpitations along with anxiety.

Anxiety sets off the body’s “fight or flight” response as part of the autonomic nervous system (ANS).

When you feel uneasy about a situation, your ANS kicks in, increasing your heart rate.

Are heart palpitations from anxiety dangerous?

Although heart palpitations can be alarming, most aren’t dangerous.

They usually go away after the anxiety-causing situation passes.

Less commonly, heart palpitations can be a sign of a serious health problem, such as arrhythmia (abnormal heart rhythm).

These heart palpitations may feel like they cause anxiety rather than follow it.

If you have palpitations along with chest pain, trouble breathing, dizziness or confusion, seek medical help right away.

How common are heart palpitations caused by anxiety?

Anxiety is the most common cause of palpitations that are not related to a heart problem.

It’s very common to have moments of anxiety, especially during stressful situations.

These situations may include job interviews, public speaking or airplane flights.

Most times, these anxious feelings and heart palpitations come and go quickly.

If you have feelings of anxiety often or for long periods, talk to your healthcare provider.

You may have an anxiety disorder or a panic disorder.

Treatment with medication, therapy or both can help relieve your symptoms.

What are the symptoms of heart palpitations and anxiety?

Symptoms of heart palpitations include:

Fluttering: Some people sense a flapping or fluttery feeling in the chest. Your heart may feel like it’s flipping.
Irregular heartbeat: You might feel like your heart skips a beat or beats out of rhythm. You may become aware of your heart rate speeding up and slowing down. You may also feel as if your heart pauses for a second or two.
Pounding: Your heart might beat forcefully or very strongly. Some people say they can feel their heart beating in their ears.

Why does anxiety cause heart palpitations?

Anxiety activates the body’s autonomic nervous system (ANS).

The ANS regulates body functions, including:

Breathing.
Digestion.
Heart rate.

When a situation causes anxiety, your ANS triggers your body’s fight or flight response.

Besides heart palpitations, you may experience:

Fatigue.
Gastrointestinal issues, such as gas and diarrhea.
Rapid breathing.
Sweating.
Tense muscles.
Trembling.

How long can heart palpitations last from anxiety?

Heart palpitations from anxiety usually go away within a few minutes.

They tend to start suddenly and end quickly.

If you have recurring heart palpitations from anxiety, your healthcare provider might diagnose an anxiety disorder.

An anxiety disorder means excessive anxiety affects your everyday activities, such as going to work or school or meeting friends.

Can you mistake other types of heart palpitations for anxiety heart palpitations?

If heart palpitations don’t go away within a few minutes or happen frequently, they may not be related to anxiety.

Less commonly, heart palpitations result from a health condition or disorder, including:

Heart rhythm problems (arrhythmias), such as atrial fibrillation (Afib).
Myocarditis, inflammation of the heart’s muscles due to a viral infection.
Thyroid problems, including hyperthyroidism.
Structural problems in the heart, such as valve disease.

How do healthcare providers diagnose heart palpitations caused by anxiety?

Your healthcare provider conducts tests to rule out other conditions before diagnosing heart palpitations caused by anxiety.

They start by listening to your heart to check for murmurs or other sounds.

They ask about your:

Current medications, including herbal supplements.
Diet.
Lifestyle, including your alcohol and caffeine intake, as both can cause palpitations.
Medical history.
Symptoms.
Your provider may suggest a blood test (complete blood count or CBC) to check for anemia or low potassium. They’ll also look for a thyroid problem or other health issues that could cause heart palpitations.

Will my healthcare provider be able to rule out other causes of heart palpitations?

Your provider will want to verify that anxiety-related palpitations aren’t dangerous.

They may recommend other tests, such as:

Chest X-ray to look at your heart and lungs.
Echocardiogram or (echo test) to examine your heart’s overall function.
Electrocardiogram (EKG or ECG) to check your heart rate.
Exercise stress test to see how your heart performs with increased activity.
Holter monitoring to record your heart’s activity over 24 to 48 hours.

If a Holter monitor doesn’t show unusual heart rhythms, your provider may give you an event recorder.

You can wear this recorder for weeks.

You press a button to record any heart sensations that you experience.

How do providers treat heart palpitations and anxiety?

If your healthcare provider diagnoses you with heart palpitations caused by anxiety, they may suggest:

Complementary health treatments: Biofeedback, massage therapy and other techniques can help you relax.
Medications: Anti-anxiety medications and antidepressants help some people. Your provider may suggest options to treat anxiety that happens when you fly or speak in public. These medicines include beta blockers (propranolol) and benzodiazepines, such as alprazolam (Xanax®) and diazepam (Valium®). Benzodiazepines can be habit-forming, so they are only for occasional use.
Psychotherapy: Cognitive behavioral therapy helps you identify and treat your thought patterns. Exposure-response prevention aims to create a positive response to fears to relieve anxiety.

How can I manage heart palpitations and anxiety?

You can try self-management techniques to help reduce the severity of heart palpitations caused by anxiety.

These techniques include:

Coping with stress.
Diaphragmatic breathing.
Exercising regularly.
Getting enough sleep.
Meditation.
Pursed-lip breathing.
Tai chi, yoga or other mindful movement.

Can I stop heart palpitations and anxiety?

You may not be able to totally prevent heart palpitations caused by anxiety.

But you can lower how often they happen and how severe they are.

First, pay attention to your triggers, such as performing in public, getting on a plane or making a phone call.

Then you can make a plan to lessen your anxiety around these situations.

Relaxation techniques, medication and therapy can all help to prevent future episodes.

What is the outlook for people with heart palpitations and anxiety?

Many people have heart palpitations caused by situational (occasional) anxiety.

You can use relaxation strategies to successfully manage this anxiety.

These strategies can slow down your heart rate in the moment.

If you have heart palpitations caused by chronic (long-term) anxiety disorders, there is hope.

You can also manage your anxiety with proper treatment.

A good team of healthcare providers can help you build a coping strategy.

If you suspect another health condition is causing palpitations — with or without anxiety — talk to your provider about treatment.

To relieve your symptoms, your provider will treat the cause.

You may also benefit from anxiety-relieving therapies.

When should I see my healthcare provider about heart palpitations and anxiety?

Always discuss any new symptoms with your healthcare provider.

Seek care right away if you have heart palpitations and:

Chest pain or discomfort.
Difficulty breathing, shortness of breath or other breathing problems.
Dizziness or confusion.
Loss of consciousness or fainting (syncope).
Severe swelling (edema) in your limbs, especially your legs, ankles and feet.
Unusual or sudden fatigue.

Anxiety is a very common cause of heart palpitations

Some people experience palpitations only in certain stressful situations, while others have palpitations more frequently.

Though you should consult your healthcare provider to rule out serious conditions, you may be able to reduce occasional heart palpitations and anxiety with relaxation techniques.

If you have heart palpitations along with chest pain, trouble breathing or dizziness, seek help immediately.

There’s no need to make a drama of it, but it’s about your health: not investigating is stupid and doesn’t solve the problem in the slightest.

References

Alijaniha F, Noorbala A, Afsharypuor S, Naseri M, et al. Relationship Between Palpitation and Mental Health. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4884607/) Iran Red Crescent Med J. 2016 Mar;18(3):e22615. Accessed 9/9/2021.
Goyal A, Robinson KJ, Katta S, Sanchack KE. Palpitations. (https://www.ncbi.nlm.nih.gov/books/NBK436016/) [Updated 2020 Nov 20]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Accessed 9/9/2021.
Merck Manual (Consumer Version). Palpitations. (https://www.merckmanuals.com/home/heart-and-blood-vessel-disorders/symptoms-of-heart-and-blood-vessel-disorders/palpitations) Accessed 9/9/2021.
National Alliance on Mental Illness. Anxiety Disorders. (https://www.nami.org/About-Mental-Illness/Mental-Health-Conditions/Anxiety-Disorders) Accessed 9/9/2021.
National Heart, Lung, and Blood Institute. Heart Palpitations. (https://www.nhlbi.nih.gov/health-topics/heart-palpitations) Accessed 9/9/2021.
National Health Service. Propranolol. (https://www.nhs.uk/medicines/propranolol/) Accessed 9/9/2021.
U.S. Department of Health & Human Services. Office on Women’s Health. Anxiety disorders. (https://www.womenshealth.gov/mental-health/mental-health-conditions/anxiety-disorders) Accessed 9/9/2021.
Wexler RK, Pleister A, Rahman SV. Palpitations: Evaluation in the Primary Care Setting. (https://www.aafp.org/afp/2017/1215/p784.html) Am Fam Physician. 2017 Dec 15;96(12):784-789. Accessed 9/9/2021.