Anxiety and Heart Palpitations: Why Your Heart Races When You Feel Anxious

Anxiety and heart palpitations are closely connected because anxiety activates the body’s fight-or-flight response, which can make the heart race, pound, flutter, or feel like it skipped a beat. In many cases, anxiety-related palpitations are temporary, but recurring, painful, or unexplained symptoms should be medically checked.

What Are Heart Palpitations?

Heart palpitations are noticeable changes in heartbeat sensation. They may feel like the heart is racing, pounding, fluttering, thumping, or briefly skipping a beat. Some people feel them in the chest, while others notice them in the throat or neck.

Palpitations can happen during exercise, stress, caffeine use, poor sleep, dehydration, medication changes, or emotional distress. They can also be linked to heart rhythm problems, thyroid issues, anemia, or other medical causes.

Because palpitations have both cardiac and non-cardiac causes, the context matters: when they happen, how long they last, what triggers them, and whether other symptoms appear with them (Wexler et al., 2017).

How Anxiety Can Cause Heart Palpitations

Anxiety can trigger palpitations through the autonomic nervous system, especially the sympathetic “fight-or-flight” response. When the brain senses danger or stress, the body releases stress hormones such as adrenaline. This can increase heart rate, tighten breathing, raise alertness, and make the heartbeat feel stronger or more noticeable.

This response is useful in real danger, but during anxiety it can happen even when there is no immediate physical threat. The result may be a racing heart, trembling, sweating, shortness of breath, or chest tightness. These sensations can then make a person feel even more anxious, creating a loop: anxiety increases body sensations, and the body sensations increase anxiety.

For some people, this loop becomes especially intense during panic attacks, where palpitations, chest discomfort, dizziness, breathlessness, and fear can peak quickly and feel alarming (Tunnell et al., 2024).

What Do Anxiety Heart Palpitations Feel Like?

Anxiety-related palpitations may feel like:

• A racing heartbeat
• A pounding sensation in the chest
• Fluttering or flip-flopping beats
• A skipped-beat feeling
• A sudden thump followed by worry
• A heartbeat that feels louder than usual

They may appear during stressful moments, after a worrying thought, before public speaking, during conflict, or while lying quietly in bed. Sometimes they happen because the body is already tense, tired, overstimulated, or sensitized to physical sensations.

A key feature of anxiety-related palpitations is that they often improve as the nervous system calms down. However, that does not mean every palpitation is caused by anxiety. New, severe, or unusual symptoms should not automatically be dismissed as stress.

Anxiety vs. Heart Problems: How to Know the Difference

It can be difficult to tell whether heart palpitations are caused by anxiety or by a heart rhythm issue because the sensations can overlap. Anxiety often causes a fast but regular heartbeat, especially during a stressful trigger. Heart rhythm problems may feel irregular, sudden, or unrelated to emotional stress, although this is not always reliable.

Medical evaluation becomes especially important if palpitations are accompanied by:

• Chest pain or pressure
• Fainting or near-fainting
• Severe shortness of breath
• Dizziness that feels intense or unusual
• A very irregular heartbeat
• Palpitations during exercise
• A known heart condition
• A family history of sudden cardiac death
• Symptoms that last longer than expected or keep returning

Panic symptoms and cardiac symptoms can look similar, and panic-related palpitations may be mistaken for heart disease while some heart conditions may be mistaken for panic. This overlap is one reason palpitations should be assessed carefully rather than assumed to be “just anxiety” (Jeejeebhoy et al., 2000).

Why Palpitations Can Make Anxiety Worse

Palpitations can feel frightening because the heart is associated with danger, survival, and control. A person may notice one unusual beat and immediately wonder, “Is something wrong with my heart?” That fear can increase adrenaline, which may make the heartbeat faster or stronger.

This creates a feedback cycle:

1. A palpitation happens.
2. The person becomes alarmed.
3. Anxiety rises.
4. The body releases more stress hormones.
5. The heartbeat feels even more noticeable.
6. The person becomes more focused on the sensation.

This is especially common in people who are highly aware of bodily sensations. The more a person checks their pulse, scans their chest, or waits for the next flutter, the more sensitive they may become to normal heartbeat changes.

Common Triggers for Anxiety-Related Palpitations

Several everyday factors can make anxiety palpitations more likely. These include stress, poor sleep, caffeine, nicotine, alcohol, dehydration, skipped meals, intense exercise, and emotional overload. Some medications and supplements may also increase heart rate or make palpitations more noticeable.

Anxiety disorders can also make physical symptoms more frequent or distressing. Research links anxiety disorders with cardiovascular symptoms and shows that anxiety is common among people with cardiovascular disease, making careful assessment important in both mental health and cardiology settings (Celano et al., 2016).

How to Calm Anxiety Heart Palpitations

When palpitations seem connected to anxiety and no urgent symptoms are present, calming the nervous system may help. Slow breathing, grounding techniques, reducing caffeine, improving sleep, and stepping away from immediate stressors can reduce the intensity of the body’s fight-or-flight response.

Helpful strategies may include:

• Breathing slowly through the nose and extending the exhale
• Relaxing the shoulders, jaw, and chest muscles
• Drinking water if dehydrated
• Avoiding extra caffeine during anxious periods
• Taking a short walk if sitting still increases body scanning
• Naming the sensation without catastrophizing it
• Using therapy techniques to reduce fear of bodily sensations

For recurring panic symptoms, cognitive behavioral therapy can help people reinterpret frightening body sensations, reduce avoidance, and break the anxiety-palpitations cycle. Evidence supports CBT and other evidence-based treatments for anxiety and panic-related symptoms (Bandelow et al., 2017).

When to See a Doctor

A healthcare professional can help determine whether palpitations are related to anxiety, lifestyle triggers, medication, or a heart rhythm issue. Evaluation may include a medical history, physical exam, electrocardiogram, blood tests, or a heart monitor if symptoms are frequent or unexplained.

It is especially important to seek urgent care if palpitations occur with chest pain, fainting, severe shortness of breath, confusion, weakness, or symptoms that feel sudden and extreme. Even when anxiety is likely, ruling out medical causes can provide clarity and reduce fear.

Can Anxiety and Heart Palpitations Be Managed?

Yes. Anxiety and heart palpitations can often be managed when the underlying pattern is understood. For many people, the goal is not to eliminate every heartbeat sensation but to reduce the fear response around it. Better sleep, lower stimulant intake, stress management, therapy, and medical reassurance when appropriate can all help.

If palpitations are anxiety-related, learning how the nervous system works can make the sensations feel less threatening. If they are not anxiety-related, proper medical evaluation helps identify the right next step.