Heart Palpitations and Anxiety

What are heart palpitations from anxiety?

Heart palpitations refer to the sensation of your heart pounding, fluttering, racing or skipping beats. You may feel your heart beating in your chest, neck or throat. The sensation may last seconds, minutes, hours or even longer.

Sometimes, palpitations come from single early or delayed heartbeats that don’t follow your heart’s normal, regular rhythm. Abnormal heart rhythms like atrial fibrillation can last a while and cause palpitations. Finally, some people feel palpitations even when their heart is in a normal rhythm. This is the case when palpitations are coming from anxiety. 

Many people have 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.

Heart palpitations from anxiety don’t last very long. Palpitations that happen frequently or don’t go away within a few minutes may not be related to anxiety.

When should I worry about heart palpitations?

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

Heart palpitations that aren’t from anxiety can come from cardiac or noncardiac conditions, including:

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

Although heart palpitations can be alarming, most aren’t dangerous. They usually go away within a few minutes — after the stressful situation passes. Heart palpitations from anxiety tend to start suddenly and end quickly.

How common are heart palpitations due to anxiety?

Anxiety is the most common cause of heart palpitations that aren’t related to a heart problem. It’s very common to have moments of anxiety, especially during stressful situations. These may include job interviews, public speaking or airplane flights. Most times, anxious feelings and heart palpitations come and go quickly.

If you keep having anxiety and heart palpitations, talk to your healthcare provider. You may have an anxiety disorder, PTSD (post-traumatic stress disorder) or a panic disorder. An anxiety disorder means that excessive anxiety affects your ability to do everyday activities, like going to work or school or meeting friends.

Anxiety disorders are the most common mental health condition in the U.S. They affect almost 1 in 5 people at some point. Treatment with medication, psychotherapy (talk therapy) or both can help relieve your symptoms.

What are the symptoms of heart palpitations from anxiety?

Symptoms of heart palpitations include:

• Fluttering: You may sense a flapping or fluttery feeling in your 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.

How does anxiety cause heart palpitations?

Anxiety activates your body’s autonomic nervous system (ANS). Your 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.
• Digestive issues, like gas and diarrhea.
• Rapid breathing.
• Sweating.
• Tense muscles.
• Trembling.

How are heart palpitations from anxiety diagnosed?

Your healthcare provider will see if there are obvious patterns or circumstances that are common to the episodes of palpitations. They’ll listen to your heart to check for murmurs or other abnormal sounds. They’ll ask about:

• Medications you take, including herbal supplements.
• Foods you eat.
• Your lifestyle, including your alcohol and caffeine intake. Both of these can cause palpitations.
• Your medical history.
• Your symptoms.

Sometimes, the story you provide is enough to make a diagnosis that anxiety caused the palpitations. In other cases, your provider may recommend extra testing. Your provider may suggest a blood test (complete blood count or CBC) to check for anemia or low potassium (hypokalemia). They may also look for a thyroid problem or other health issues that could cause heart palpitations. They may order an electrocardiogram or request a wearable rhythm monitor if they suspect a heart problem is causing your palpitations.

What tests will be done to diagnose heart palpitations from anxiety?

Your provider will want to make sure that anxiety-related palpitations aren’t dangerous. They may recommend other tests, like:

• Chest X-ray to look at your heart and lungs.
• Echocardiogram 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.
• A Holter monitor 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 feel.

How are heart palpitations from anxiety treated?

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

• Complementary health treatments: Biofeedback, massage therapy and other techniques can help you manage stress and anxiety.
• Medications: Anti-anxiety medications (anxiolytics) and antidepressants help some people. Your provider may suggest options to treat anxiety that happens in specific situations, like when you take a flight or speak in public. These medicines include beta-blockers and benzodiazepines. Benzodiazepines can be habit-forming, so they’re only for occasional use.
• Psychotherapy: Cognitive behavioral therapy (CBT) helps you identify and change your thought patterns. Exposure-response prevention aims to create a positive response to fears to relieve anxiety.

How to stop palpitations caused by anxiety

Palpitations from anxiety aren’t harmful to your body, but they can create uncomfortable feelings. Following these suggestions may help reduce the severity of heart palpitations from anxiety. These methods include:

• Coping with stress.
• Using diaphragmatic breathing.
• Getting regular physical activity.
• Getting enough sleep.
• Practicing meditation.
• Using pursed-lip breathing.
• Using tai chi, yoga or other mindful movement.

Can heart palpitations from anxiety be prevented?

You may not be able to totally prevent heart palpitations from anxiety. But you may be able to reduce how often they happen and how severe they are.

First, pay attention to your triggers, like 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 can I expect if I have anxiety and heart palpitations?

Many people have heart palpitations from situational anxiety that happens now and then. 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 because of chronic (long-term) anxiety disorders, there’s hope. You can 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?

Talk to your provider if you have heart palpitations from anxiety but no other symptoms. Always discuss any new symptoms with your provider.

When should I go to the ER?

Seek emergency 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.

What questions should I ask my healthcare provider?

Questions to ask your provider may include:

• Is there a support group you can refer me to for help with anxiety?
• Can you teach me relaxation techniques?
• How much sugar and caffeine can I have each day?

A note from Cleveland Clinic

A stressful situation like hearing bad news about a loved one can set off anxiety and heart palpitations. Having emotions is part of being human. But some people experience palpitations only in certain stressful situations, while others have palpitations more frequently. Talk to a provider about ways to reduce heart palpitations and anxiety with relaxation techniques or other treatments. Asking for help isn’t a sign of weakness. It means you’re speaking up for yourself.