Why does anxiety cause heart palpitations?
Anxiety causes mental and physical responses to stressful situations, including heart palpitations. When a person feels anxious, this activates a fight or flight response, which increases their heart rate.
During an anxiety attack, a person’s heart feels like it is racing or pounding. According to the National Alliance on Mental Illness (NAMI), this is a major symptom of panic disorder, a type of anxiety disorder.
Anxiety and heart palpitations
The Office on Women’s Health (OWH) explain that anxiety is a normal response to stress. It is a coping mechanism that the body uses to stay alert during challenging circumstances.
With anxiety disorders, the body is overly reactive to stress, and a person may feel constant apprehension or dread or even experience sudden attacks of anxiety without warning.
Anxiety activates the autonomic nervous system (ANS), which is an involuntary response. The ANS works unconsciously and regulates functions, such as heart rate, breathing, and digestion.
The ANS consists of the sympathetic nervous system and the parasympathetic nervous system.
The sympathetic nervous system is responsible for the fight-or-flight response. This controls how the body reacts to situations that it perceives to be stressful or dangerous.
When the sympathetic nervous system is active, bodily functions, such as digestion, stop temporarily, and heart rate and blood pressure increase.
The parasympathetic nervous system, also known as the rest and digest system, maintains bodily functions, such as digestion, when a person is resting. It will also reduce heart rate and blood pressure after a fight-or-flight response.
The parasympathetic system and sympathetic system work together to maintain homeostasis — which is when the body is in a balanced state.
Triggers and responses to anxiety disorders depend on individual experiences and the type of anxiety disorder a person has.
According to NAMI, examples of anxiety disorders include:
- generalized anxiety disorder
- panic disorder
- social anxiety disorder
- separation anxiety disorder
For instance, social anxiety disorder causes more psychological responses, such as intense worrying and irrational thoughts. In contrast, panic disorder causes more physical symptoms, such as heart palpitations.
Other symptoms of anxiety
According to NAMI, there are different types of anxiety disorders, so symptoms depend on the individual and the type of anxiety they have. However, all types of anxiety present several key symptoms.
Emotional symptoms include feelings of:
Physical symptoms include:
- a headache
- disturbed stomach functions
- heart palpitations
Diagnosing anxiety palpitations
Heart palpitations can be a symptom of anxiety and not a major cause for concern — providing the person is aware of the trigger, and the palpitations stop when the anxiety subsides.
An article in the American Family Physician journal suggests palpitations due to anxiety are more common in people who experience a lot of daily irritation, and those who are sensitive to sensations in their body.
Doctors diagnose heart palpitations under five categories of causes:
- cardiac arrhythmias, such as bradycardia
- psychiatric, linked to anxiety disorders and panic attacks
- drugs and medication
- nonarrhythmic cardiac causes, such as valvular disease
- extracardiac causes, which come from outside the heart
To diagnose anxiety palpitations, a doctor will begin with a screening questionnaire. This will help them identify people who are likely to have palpitations from anxiety. A doctor will refer anyone who passes a certain score for monitoring.
A doctor may use a Holter monitor or a transtelephonic event monitor.
A doctor may consider using a Holter monitor if a person experiences palpitations on a daily basis. A Holter monitor is a basic ECG device that continuously monitors a person’s heartbeat over 24–48 hours. The person must wear the Holter device throughout the monitoring period and record any symptoms.
A transtelephonic event monitor is smaller than a Holter monitor and does not run for the whole period. Although the person wears it continuously, they operate the monitor manually.
Some types of transtelephonic monitors require a person to hold it against their chest only when they think they are experiencing palpitations.
The results of these assessments must eliminate all other potential causes before a doctor can make a diagnosis of anxiety-induced heart palpitations.
Once a doctor confirms that an anxiety disorder is the cause of the heart palpitations, they may refer a person to a therapist for treatment.
A doctor will consider the person’s individual preferences when designing a treatment plan for anxiety.
According to the OWH, options may include:
- complementary approaches
Treatment plans may use a combination of these strategies to target symptoms of anxiety, including heart palpitations.
According to NAMI, a therapist will help a person identify the causes of their anxiety attacks and find ways to work through them.
Exposure-response prevention is a specific type of psychotherapy that aims to reduce attacks by creating a positive response to triggers. This method gradually eases people into exposing themselves to their fears, so they develop coping mechanisms.
A therapist may also recommend a person tries cognitive behavioral therapy (CBT). This type of therapy targets a person’s thinking patterns, such as counterproductive thoughts that contribute to their anxiety.
Medications can also help treat anxiety disorder, and a doctor can prescribe a suitable option.
Some medications specifically treat anxiety, but doctors may also prescribe antidepressants such as selective serotonin reuptake inhibitors (SSRIs).
A person must speak to a doctor if their medication is not working for them or causes side effects.
There is a range of home-based techniques that a person can use to reduce anxiety.
NAMI suggest that self-management can help a person contain their anxiety. Self-management aims to help a person increase control of their anxiety by learning about the condition and setting aside a time each day to focus on managing it.
Yoga or other relaxation activities can help with anxiety by soothing the mind. Other forms of exercise, such as running, can also relieve stress and anxiety.
However, these techniques are not always possible or practical, so it is important to talk to a doctor to discuss treatment options.
Anxiety palpitations or “A-fib”?
According to the American Heart Association (AHA), A-fib, short for atrial fibrillation, is an irregular heartbeat that can increase the risk of a stroke.
A-fib can produce symptoms that are similar to anxiety palpitations as the heartbeat becomes rapid and causes chest pain.
The table shows the main differences between symptoms.
|Anxiety palpitations||A-fib palpitations|
|People with anxiety are more aware of their heartbeats, so they panic more||A person with A-fib may be less aware of their heartbeats before palpitations begin|
|Anxiety palpitations are gradual||Palpitations are sharp and intense|
|Racing heart maintains rhythm||The heartbeat flutters, losing rhythm|
Other causes of palpitations
Research shows that anxiety is not the only cause of heart palpitations. A person may experience a change in heart rate from:
- lifestyle triggers
- a fever
- heart problems
The first thing a doctor will check is whether a cardiac problem is causing the palpitations.
Learn more about the symptoms of a heart attack here.
When to see a doctor
Anyone experiencing heart palpitations must see a doctor so treatment can start as early as possible.
See a doctor urgently if palpitations:
- occur frequently
- last for extended periods
- have no known cause or trigger
Most people with anxiety disorders develop symptoms before the age of 21, though late-onset anxiety is also possible. When a person begins treatment, the palpitations should start to cease. If not, they should get in touch with a doctor to discuss other treatment options.
A person cannot prevent anxiety with heart palpitations completely, but they can reduce the severity by understanding triggers for attacks and developing ways of tackling these.
It is essential to identify the reason for palpitations in case there is a more critical underlying cause.
Anxiety disorders affect 19.1% of adults in the United States, making anxiety the most common mental health problem.
Some types of anxiety involve more physical symptoms, while others are more psychological. Heart palpitations are a physical symptom. They are particularly common in panic disorder.
Treating anxiety will lower the frequency of panic attacks, reducing palpitations as a result.