When you feel anxious, the body responds with physical symptoms, such as shaking, sweaty palms, or an upset stomach. Sometimes, it may even feel like your heart is fluttering, pounding, racing, or skipping a beat – a condition known as heart palpitations.
It is normal to experience heart palpitations after engaging in rigorous activities that get your heart rate up, such as exercising. However, palpitations sometimes hit without warning. You may begin to feel as if your heart is beating forcefully or skipping beats out of rhythm. Some people say they feel their heart beating in their ears. To determine whether your heart palpitations¹ are caused by anxiety or a more serious condition, it can be helpful to understand the link between anxiety and heart palpitations.
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Anxiety is a normal response to a stressful situation, such as speaking in public, going to a job interview, undergoing surgery, or any other situation that makes you feel nervous or unsure. Anxiety episodes can be short-lived with few symptoms, or long-term with serious mental and physical health implications.
Sometimes, anxiety can cause physical symptoms in the form of a panic attack. This feels like a sudden rush of fear or discomfort, with associated physical symptoms that include sweating, nausea, stomach pain, or fast breathing.
Anxiety causes heart palpitations by activating the body's autonomic nervous system (ANS)² that regulates body functions such as digestion, heart rate, and breathing. The ANS activates the body's fight-or-flight response, causing heart palpitations and other symptoms, such as fatigue, rapid breathing, sweating, trembling, tense muscles, and gastrointestinal issues (diarrhea, bloating, gas).
However, if your heart palpitations are not the result of anxiety, there can be a more serious physical cause. These include:
Heart palpitations can be caused by heart conditions such as arrhythmia³, a problem with the electrical system that controls your heartbeat. Several types of arrhythmias exist, each with its own unique symptoms, but all feature an irregular heart rate.
Tachycardia – This condition causes exceptionally fast heartbeats. Episodes may last for just a few minutes or much longer. Medical professionals may need to administer medication or perform a procedure to correct the electrical activity to make your heartbeat normally with a steady rhythm.
Atrial fibrillation – This condition occurs when the upper heart chambers (atria) beat irregularly instead of in a synchronized manner with the ventricles (lower chambers).
Bradycardia – This condition feels more like a slow, persistent thudding than palpitations. It occurs when the heart beats at less than 60 beats per minute.
Consuming one or more alcoholic drinks over a certain period of time can cause your heartbeat to increase. People who don't drink often but do so at the occasional event may feel chest flutters.
More research is being conducted on how high-caffeine beverages such as coffee and energy drinks may trigger heart rhythm disturbances and other problems. Caffeine sensitivity varies from person to person. You may drink two cups of coffee or tea in the morning and feel fine, whereas another person may develop headaches, palpitations, and other side effects.
Cold medicines containing pseudoephedrine may activate heart palpitations and jittery feelings. Other medications such as salbutamol (asthma relievers) can also cause palpitations, as can illicit substances. Hyperthyroidism (overactive thyroid) or anemia can be another cause of tachycardia/palpitations.
Everyone feels anxious from time to time. Whatever situation you are facing, you can calm your body’s flight-or-fight response and lower your heart rate. The following techniques can help:
Taking deep breaths – Control your breath by taking slow, deep breaths in through the nose and out through the mouth at least ten times in a row. This can help you to relax and lower your heart rate. Deep, consistent breathing at a controlled pace tells your parasympathetic nervous system to relax the body.
Focusing your mind – When the heart races, your mind can follow. To stop it, try focusing on and visualizing a relaxing phrase (a mantra such as “This will pass”), image, or sound. Concentrate on the sensation of the breath expanding and contracting the abdomen. Focusing the mind is also a healthy practice even when you are not stressed to help with day-to-day well-being.
Walk – A gentle walk, ideally in nature, can give you fresh air and relieve anxious energy to calm you down. A slow walk is best to help lower your heart rate.
Hydration – Dehydration can worsen heart palpitations. Make sure to drink enough water and supplement with electrolytes (such a sports drinks or getting the right amount of sodium) if you have been exercising. Avoid caffeine since it triggers more anxiety and palpitations.
If you experience palpitations without an anxiety-inducing cause, you should immediately notify your doctor or consult a cardiologist. There may be a simple cure, as it could be a side effect of the medication you are taking.
If your heart palpitations are triggered by anxiety, they tend to subside on their own and you usually won’t need to see a doctor. However, anxiety-related palpitations that last for a long time or prevent you from functioning normally need to be assessed by a medical professional.
If you have heart palpitations and do not know the cause, you need to see your doctor as soon as possible. Your doctor can have you undergo various tests to find the cause. They may perform a physical examination, use a stethoscope to listen to your heart, and order diagnostic tests such as an electrocardiogram⁴, an exercise test, Holter monitoring, or cardiac event recording.
Anxiety is a common cause of heart palpitations and usually isn’t something to worry about. However, it is normal for your heartbeat to speed up in stressful situations, sometimes palpitations may become more frequent, intense, unpredictable, or impact your general functioning and well-being. If you are concerned about heart palpitations, contact your doctor to discuss the reasons and, if necessary, provide treatment.
Skipping a beat — the surprise of heart palpitations | Harvard Health Publishing
Arrhythmia | National Heart, Lung, and Blood Institute
Electrocardiography | Medscape