Heart palpitations: Do I have an abnormal rhythm or is it anxiety?

You’re standing in the house, washing up, waiting for a bus, even getting ready for bed in the evening and there it goes again – your pulse suddenly pounding and racing in your chest.

We all know heart rates speed up a little with strenuous exercise, or momentarily leaps if we get a sudden fright – but what if you’re getting palpitations when there’s no obvious cause? Is it stress and anxiety, or could it be a problem with your heart?

Arrhythmia – the medical term for an abnormal or irregular heart rate or rhythm – is associated with a range of potential conditions, some of which can be very serious and will need to be monitored and treated. Here’s what you need to know.

Can anxiety cause heart palpitations?

“Many people do experience palpitations as a symptom of anxiety and panic attacks, and it is common for people to have palpitations when they are anxious,” says Yuko Nippoda, psychotherapist and spokesperson for the UK Council for Psychotherapy (UKCP).

This is due to the body’s ‘fight or flight’ response, which can happen in moments of acute stress, causing a spike in cortisol and adrenalin levels. These stress hormones can bring on a number of physiological responses, including a sudden rise in heart rate – an inbuilt survival mechanism preparing us to take quick action.

Ideally, this is just temporary and things balance out again. But when people are dealing with ongoing or chronic stress and anxiety, that heightened state can linger.

Nippoda says it’s normal for people experiencing anxiety-induced palpitations to “worry there might be something wrong with their heart”.

“When they have palpitations, they might become more anxious, as the heart is a vital organ for life. However, the more they become anxious, the more likely they’ll have palpitations, and this might become a vicious circle,” she explains.

How else can you tell if anxiety is affecting your body?

If stress or anxiety is the culprit, chances are there will be other indicators too. “When people have anxiety and panic attacks, they become shaky, sweaty, nauseous, tense, restless, and find it difficult to sleep. They can also have abdominal discomfort,” says Nippoda.

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You might also feel generally tense and on edge, and perhaps seem more impatient and irritable and struggle to relax. Sometimes, it’s quite clear that you’re under pressure and have a lot on your plate, although anxiety doesn’t always have an obvious external cause.

Always get things checked

All that being said, as Nippoda adds: “On the other hand, palpitations may well be due to physical illness, so those who are really worried should seek medical advice, to be on the safe side.”

When it comes to heart symptoms, it’s always best to get things properly checked out – sooner rather than later. It’s a message Dr Oliver Segal, consultant cardiologist and electrophysiologist at The Harley Street Clinic, part of HCA Healthcare UK, also wants to highlight.

“While palpitation can certainly be stress-related or due to anxiety, it isn’t possible to tell the difference between this and a genuine heart rhythm problem. Egg monitoring and other tests are necessary for reassurance,” says Segal.

This is especially the case if you’re also experiencing other physiological symptoms.

“If you also feel breathless, have chest pain or feel faint, dizzy or pass out, then these are all potential red flags,” says Segal. “Symptoms which occur without stress are naturally more likely to be heart-related, as are symptoms that wake you at night. Symptoms with exercise can sometimes be very serious and should be checked out.”

How is arrhythmia diagnosed and treated?

Your GP will usually start by asking about your symptoms and history, as well as listening to your heart and checking your pulse and blood pressure. Segal explains that specific tests can help detect heart rhythm issues: “Usually, an ECG, echocardiogram (ultrasound scan of the heart), ECG monitor (often a patch monitor), and blood tests are needed.”

Common arrhythmia conditions include atrial fibrillation (AF), which causes an abnormally fast, irregular heart beat and is particularly likely in older age groups, and supraventricular tachycardia (SVT), which causes the heart to suddenly beat much faster for bursts lasting a few minutes to several hours. Heart block, meanwhile, is associated with an abnormally slow heart rate, sometimes also with an irregular rhythm.

Treatments depends on the type and severity of the condition, possibly including medication, pacemakers and procedures such as catheter ablation (where a thin tube is inserted via a vein or artery to correct problems with the heart’s electrical signals).

While not all arrhythmias are serious, some (such as AF) are linked with a significantly higher risk of things like stroke and heart attack. “Early diagnosis and treatment can often prevent this,” says Segal. “Sometimes frequent ectopic beats can be a sign of heart failure, putting you at risk of collapse or cardiac arrest. Again, early diagnosis is key to avoiding these.”

And if underlying heart problems are ruled out, and stress/anxiety is causing your palpitations, getting the appropriate advice and support can make a big difference here too. Breathing exercises can bring quick relief, while longer- term support with talking therapies and sometimes medication may also be beneficial.

Bottom line, when it comes to heart symptoms, don’t self-diagnose.

“Self-diagnosis is never a good idea – even for doctors!” says Segal. “We see plenty of people who waited too long to get tested and now regret that decision. It is always best to get checked out early for reassurance.”