Anxiety is a common emotion that often sets in before giving a speech, undergoing surgery, or any other situation that makes you fearful or unsure. Anxious episodes tend to be temporary with few serious symptoms or long-term health effects.

Typical signs of anxiety include feelings of nervousness and tension, as well as sweating and an uneasy stomach. One other common symptom of anxiety is an abnormally increased heart rate, also known as heart palpitations.

Heart palpitations can feel like your heart is racing, pounding, or fluttering. You may also feel as though your heart is skipping a beat. Unless your palpitations are caused by a heart rhythm disorder, known as an arrhythmia, they tend to be short-lived and harmless.

Anxiety is a response to stress, which in itself is a response to a perceived threat. The threat may be real, like a hurricane barreling toward a coastal community, or it may be one that we build up in our minds, such as a child worrying about a monster under the bed.

But anxiety’s impact isn’t just isolated to the mind. It’s a feeling that activates the body’s autonomic nervous system (ANS), also known as the “fight or flight response.” The ANS helps regulate the functions of the:

  • heart
  • lungs
  • digestive system
  • various muscles throughout the body

You don’t think about it much because the ANS operates involuntarily. You don’t need to concentrate on your heart to have it beat faster when you’re exercising, for example.

Individual response

Each person responds to stress and anxiety a little differently. And what makes one person anxious may have the opposite effect on someone else. You may be petrified at the thought of singing in public, but you may know people who happily get up and belt out a song whenever they get the chance.

If you’re in a situation that is making you anxious, heart palpitations are just one sign that the ANS has kicked into gear. Other physical symptoms can include:

Anxiety can also make you want to avoid the situation that is causing your uneasy feelings. This, of course, can mean you miss out on potentially fun and rewarding things like activities, job opportunities, and relationships.

In addition to anxiety, there are several other causes of heart palpitations. Palpitations can be brought on by:

  • Alcohol. Having one or two too many drinks in a night can get your heart racing. People who rarely drink to excess, but do so at the occasional party may feel a fluttering in their chest later. This is sometimes called “holiday heart.”
  • Caffeine. Each person’s caffeine sensitivity is unique. You might drink three cups of coffee every morning and feel fine. A co-worker might try that and develop palpitations, headache, and other side effects. With the popularity of high-caffeine beverages, such as specialty coffees and canned energy drinks, researchers are learning more about how high levels of caffeine can lead to heart rhythm disturbances, high blood pressure, and other problems.
  • Chocolate. Palpitations can develop from eating too much at one sitting. Overdoing your food intake at a dinner or other event can lead to a version of “holiday heart.” Chocolate is particularly associated with palpitations.
  • Medications. Cold medicines that contain pseudoephedrine may trigger heart palpitations and jittery feelings.

For some people, palpitations are signs of an arrhythmia, a problem with the heart’s electrical system that controls your heartbeats. A normal, resting heart rate is between 60 and 100 beats per minute. There are several types of arrhythmias. Each type produces unique symptoms, including an irregular heart rate. Among them are:

  • Tachycardia. In this condition, the heart beats exceptionally fast. Episodes may last a few minutes or much longer. In some cases, doctors can perform a procedure on the heart to better control electrical activity and return your heart to a normal, steady rhythm.
  • Bradycardia. This condition occurs when the heart beats slower than 60 beats per minute. It feels less like palpitations, and more like a slow thudding. But it can still be troubling to experience.
  • Atrial fibrillation. This arrhythmia occurs when the heart’s upper chambers (atria) beat chaotically instead of in a synchronized manner with the lower chambers (ventricles).

Occasional moments of anxiety are normal, especially if you can identify the cause of your anxiety, such as getting on an airplane or preparing for a job interview. These feelings don’t require a doctor’s evaluation unless the anxiety becomes so overwhelming in these situations that it interferes with your ability to function.

If you experience anxious feelings frequently or if you find yourself experiencing anxiety and you’re not sure why, tell your primary care physician or seek out a mental health professional for help. You may have an anxiety disorder that could be managed with a combination of therapy and medication.

Diagnosing an anxiety disorder often starts with a physical examination by a doctor. Certain conditions may cause anxiety, such as:

Blood tests and other screenings may be ordered if a physical condition is suspected of causing anxiety.

A mental health professional will also review your symptoms and go through a questionnaire or other psychological screening to help make a diagnosis. Here are a few places to help you find a mental health professional in your area:

If palpitations come on with identified episodes of anxiety and then subside quickly on their own, you don’t need to tell your doctor. Anxiety-triggered palpitations that last for hours or keep you from functioning normally (going to work or socializing, for example) should be evaluated.

Likewise, if palpitations appear without an anxiety-inducing cause, you should definitely tell your doctor or see a cardiologist. It may be something easily treatable, like a medication side effect that can be resolved by switching drugs. A racing heart could be a sign of:

There are a few different tests your doctor can use to help identify what’s going on in your chest. They’ll first give you a physical examination and listen to your heart with a stethoscope. Then, they may use one or more of the following diagnostic screenings:

  • Electrocardiogram. Several electrodes are placed on your chest to measure electrical activity of the heart. It can help diagnose an arrhythmia or rule out a heart rhythm problem.
  • Holter monitoring. This involves a special device that you wear 24 hours a day to record your heart rate and any changes that occur. It’s usually only worn for up to three days at a time, and may not “catch” any palpitations if you have them infrequently.
  • Event recording. This is often used if a Holter monitor doesn’t pick up any rhythm abnormalities. The recorder can be worn for weeks at a time, but it only records your heart rhythms when you press a button while having symptoms.

If feelings of anxiety bring on heart palpitations, there are some steps you can take to relax and slow down your racing heart. Some proven relaxation strategies include:

Regular exercise and getting at least seven to eight hours of sleep per night are two other ways to help you reduce stress in your life. Avoiding stressors is also important. This can mean:

  • taking alternative roads if your usual traffic route is stressful
  • avoiding certain topics of conversations with people who tend to argue with you
  • removing clutter from your home
  • spending more time connecting positively with friends and family

While anxiety can cause palpitations, the episodes can be eased by learning relaxation techniques, discussing de-stressing strategies with a therapist, and medication. Schedule an appointment with your doctor or a mental health professional if you think your heart palpitations could be caused by anxiety.