Heart Palpitations From Anxiety: How to Tell and When to Worry

Your heart suddenly pounds, skips, or races, and your next thought is the scary one. Is this anxiety, or is something wrong with my heart? It’s okay to not have all the answers right now, and the honest answer starts with checking your heart, then caring for your nerves.

When your brain senses danger, real or not, your nervous system flips into fight-or-flight. Stress hormones speed up your heart and make it beat harder, and many people with anxiety become highly tuned in to every beat. A 2013 cardiology review lists a racing or pounding heartbeat among the core symptoms of a panic attack, and notes that a common rhythm problem can cause very similar symptoms. Figuring out what’s behind yours takes precision.

The standard approach starts with your heart, and it works well. In a classic 1996 study in the American Journal of Medicine, doctors found the cause of palpitations in 84% of 190 patients, often with just a history, exam, ECG, and basic labs. One-year outcomes were reassuring, with low rates of death and stroke. For most people, that workup gives a clear answer.

But a single normal ECG can miss rhythm problems that come and go, and at Siggy we don’t think “it’s just anxiety” should be said until the heart has had a fair look.

The better path pairs a proper cardiac rule-out with real treatment for the anxiety behind the pounding, so you aren’t stuck choosing between an ER visit and being told to relax. It addresses the same frightening heartbeat with fewer missed diagnoses on either side. That approach follows the evidence on how anxiety and arrhythmias overlap, not a guess about which one you have.

What This Page Covers

• Why Does Anxiety Cause Heart Palpitations?
• How Often Are Palpitations Caused by Anxiety?
• Can You Tell Anxiety From a Heart Rhythm Problem by Feel?
• When Should You Worry About Palpitations?
• What Tests Rule Out a Heart Problem?
• How Can You Calm Anxiety Palpitations in the Moment?
• What Treats Palpitations Driven by Anxiety?
• How Siggy Fits In
• Start Your Anonymous Intake

Why Does Anxiety Cause Heart Palpitations?

Palpitations are the feeling of your own heartbeat: pounding, fluttering, racing, or a skipped beat. Anxiety produces them in two ways.

First, the stress response is physical. Adrenaline and related hormones raise your heart rate and the force of each beat. Second, attention changes what you notice. In a 1992 panic study, people with panic disorder reported more awareness of their heartbeat than comparison groups and were better at silently counting their own heartbeats, though later studies have been mixed on that accuracy. That heightened attention can set off a loop: you notice a beat, feel afraid, your heart speeds up, and the fear grows. Our guide to anxiety attack symptoms describes the other physical sensations that often come with it.

How Often Are Palpitations Caused by Anxiety?

Often, but not always. In the American Journal of Medicine study, the cause of palpitations was cardiac in 43% of patients, psychiatric in 31%, miscellaneous in 10%, and unknown in 16%. Within a year, 75% had palpitations again, even though serious outcomes were rare.

Other causes matter too. A family medicine review in American Family Physician lists psychiatric illness, side effects of prescription and over-the-counter medicines, and substance use alongside heart conditions as causes clinicians should consider.

Can You Tell Anxiety From a Heart Rhythm Problem by Feel?

Not reliably, and that’s the part most people don’t hear. Paroxysmal supraventricular tachycardia (PSVT) is a common, treatable rhythm problem that causes sudden bursts of fast heartbeat. In a 1997 study of 107 people with PSVT, 67% met diagnostic criteria for panic disorder.

The arrhythmia went unrecognized after the first medical evaluation in 55% of them and stayed unrecognized for a median of 3.3 years. Before the real cause was found, doctors attributed symptoms to panic, anxiety, or stress in 54% of the missed cases, and women were dismissed this way more often than men, 65% versus 32%. Once identified, treatment resolved symptoms in 86%.

None of this means your palpitations are a heart problem. It means anxiety should be a conclusion reached after your heart has been checked, not a first guess.

When Should You Worry About Palpitations?

Call 911 if palpitations come with chest pain or pressure, fainting or nearly fainting, severe shortness of breath, or confusion. Our guides to anxiety chest pain and anxiety shortness of breath explain how to think about those symptoms.

For everything else, the American Family Physician review identifies features that raise the odds of a cardiac cause:

What You Notice	Why It Matters	Next Step
History of heart disease	Higher chance of cardiac cause	Prompt clinician visit
Palpitations at work or that disrupt sleep	Higher chance of cardiac cause	Heart evaluation
Family history of rhythm problems	Raises concern for arrhythmia	In-depth evaluation
Symptoms with exertion	Possible ischemia or heart failure	Heart evaluation
Abnormal ECG or exam	Points to heart disease	Further testing

If none of these apply and episodes match your anxiety pattern, it’s still worth a baseline check once, especially if palpitations are new.

What Tests Rule Out a Heart Problem?

Most evaluations start with a history, physical exam, and resting ECG, which can sometimes reveal an underlying rhythm issue even between episodes. In the classic palpitations study, that simple initial evaluation, plus basic labs, identified the cause in 40% of patients.

When episodes come and go, the type of monitor matters. In the PSVT study, a 24- to 48-hour Holter monitor detected the arrhythmia in only 9% of patients who wore one, compared with 47% for an event monitor worn longer and activated during symptoms. If your palpitations are occasional, ask whether a longer-term monitor makes sense.

How Can You Calm Anxiety Palpitations in the Moment?

These steps are for people whose heart has been checked, or whose episodes clearly match a known anxiety pattern. If a symptom feels new or different, seek care first.

Slow Your Breathing

Breathe in through your nose for about four seconds, then out slowly for about six. Training this kind of slow, paced breathing has real evidence: a 2017 meta-analysis of 24 studies found heart rate variability biofeedback, which teaches slow breathing, produced a large reduction in self-reported stress and anxiety.

Ground Yourself

Grounding pulls your attention out of the heartbeat loop. Try naming five things you can see, four you can touch, three you can hear, two you can smell, and one you can taste. Press your feet into the floor and notice the pressure.

Stop Checking

Repeatedly taking your pulse or watching a heart-rate app can feed the heartbeat-and-fear loop described above. After you’ve been evaluated, agree with your clinician on when a reading truly warrants action, and let the rest go. Our guide to health anxiety covers this checking cycle, and our guide on how to reduce anxiety immediately has more in-the-moment tools.

What Treats Palpitations Driven by Anxiety?

When anxiety or panic disorder is the cause, treating it treats the palpitations. Cognitive behavioral therapy teaches you to reinterpret body sensations without fear, and a Cochrane network meta-analysis found it was the most studied psychological therapy for panic disorder and often outperformed others, though the differences were small. Medication can also help: a 2022 BMJ meta-analysis of 87 trials found SSRIs combined high remission rates with a low risk of adverse events for panic disorder, and sertraline and escitalopram performed especially well. The authors note the underlying studies had moderate to very low certainty, so individual responses vary.

SSRIs work gradually, and finding the right medication and dose can take time. Our guide to how long anxiety medication takes to work explains what to expect, and a prescriber can adjust if the first choice isn’t right.

How Siggy Fits In

“I’d be comfortable using AI as long as a real doctor is reviewing it.” With symptoms that feel this physical, that review matters even more.

Siggy doesn’t evaluate heart rhythms or replace a cardiac workup, so start there if you haven’t been checked. If your heart has been cleared and anxiety or panic is still sending your pulse racing, Siggy’s prescribers focus on exactly that. The free, anonymous intake takes no name, email, or login, so you can describe your episodes honestly. It gathers structured information and doesn’t diagnose you on its own. A licensed prescriber reviews your intake before anything is prescribed, and your downloadable summary can be shared with your primary care clinician or cardiologist.

Siggy isn’t an emergency service. If palpitations come with chest pain, fainting, or severe shortness of breath, call 911. If you’re in a mental health crisis, call or text 988. This article is for education and isn’t a substitute for personal medical advice. It reflects sources available as of November 2026.

Start Your Anonymous Intake

Anxiety is a common cause of heart palpitations, but it shouldn’t be assumed. Some treatable rhythm problems feel exactly like panic, so the right order is a fair cardiac check first, then real care for the anxiety if that’s what’s driving it. Slow breathing and grounding help in the moment, and evidence-based treatment can quiet the pattern over time. If physical symptoms of anxiety are showing up in other ways, our guide to anxiety and high blood pressure is another useful read. When your heart has been checked and you’re ready to treat the anxiety behind the pounding, start your anonymous intake with Siggy. It’s free, and no name or email is required.