Heart palpitations, anxiety and when to get checked

It feels like your heart stops. Then it starts again, with a thump you feel in your throat. The whole thing lasts less than a second. That sensation is a palpitation, which is the medical word for becoming aware of your own heartbeat, and it is one of the most common things anybody takes to a GP. There is a decent physical explanation for why it feels precisely like that, and having it takes some of the fear out.

The short version

• Palpitations are common, and the NHS is clear that they are usually not a sign of anything serious.
• The beat you think you missed is often the beat that came after the gap. That is why it lands as a thud rather than an absence.
• Anxiety changes both your heart rate and how loudly you notice it, so it can make an ordinary heart feel like an emergency.
• None of that makes anxiety a diagnosis you can give yourself. There is a short list of symptoms that need checking, and the most useful record anyone can get is a heart tracing, an electrocardiogram (ECG), taken while it is actually happening.

What you are actually feeling

Most of these episodes are extra beats, fired slightly early by a bit of heart muscle that has jumped its turn. A position paper from the European Heart Rhythm Association describes it in almost those words: a missed or skipped beat, a sinking feeling, the heart seeming to stop and then start again, sometimes with an almost painful blow to the chest.

Here is the reassuring part. With extra beats, that thump is not the heart failing to beat. The explanation the paper puts first is close to the opposite. The beat after the early one contracts harder than usual and shifts the heart further inside the chest, so what you are feeling is a beat that is too big rather than a beat that is missing. The paper offers two other candidates as well, the pause itself and the unusual way the heart is triggered during an extra beat, and it is straight about the fact that the mechanism is not settled. Extra beats like these turn up often in young people with no heart disease, and the paper calls their outlook generally benign.

Why it feels so much worse than it is

Two things stack up. The first is obvious: anxiety speeds and unsettles the heart, which is why the NHS lists stress and anxiety among the common causes of palpitations, next to poor sleep, hard exercise, caffeine, alcohol and nicotine. I have covered that machinery in the physical symptoms of anxiety. The same NHS page also lists causes a blood test picks up, including an overactive thyroid and iron deficiency anaemia, which is one reason this is not a call to make on your own.

The second is quieter and matters more here. Anxiety turns up the volume on the signal. The same position paper describes a centrally mediated fright reaction, in which a normal rhythm, or a trivial irregularity in it, is both noticed and badly tolerated. A review for primary care doctors is blunter: awareness of the heartbeat is heightened in people who are sedentary, anxious or low and reduced in people who are active and content, and palpitations are sometimes felt when nothing abnormal is happening in the heart at all.

The same heart, on the same day, is a background hum to one person and a siren to another. That difference is not imagination. It is perception.

Anxiety is not a diagnosis you can hand yourself

Clinicians do use the shape of an episode as a clue. Anxiety-driven palpitations tend to build and fade gradually and run slightly fast rather than racing, where extra beats and fast rhythms start and stop abruptly. But the paper is careful about how far that goes. People cannot always describe their symptoms accurately, most individual features turn out to be weakly predictive, and a fast heart rate driven by something systemic also comes on gradually. It is a clue for a clinician, not a test for you.

This is the part I would underline. The paper describes a study of patients with a confirmed fast heart rhythm, supraventricular tachycardia, who had first been told they were having panic attacks. It also notes that anxiety and heart rhythm problems are not mutually exclusive, and that the adrenaline surge of intense anxiety may make some arrhythmias more likely as well as more noticeable. You can have both. Plenty of people do.

So the conclusion the paper draws is not reassurance. It is that a physical cause should be looked for properly before it is dismissed, even in someone with a known anxiety problem. The NHS puts it more simply. Do not self-diagnose.

When to get it checked

Call 999 or go to A&E if you have palpitations that will not go away, or palpitations along with chest pain, shortness of breath, or feeling faint or fainting. Do not drive yourself. Ask someone to drive you, or call 999 for an ambulance. If those symptoms have already stopped, ask your GP surgery for an urgent appointment or contact NHS 111.

See a GP if you feel well but the palpitations keep coming back or are happening more often, if they last longer than a few minutes, if you already have a heart condition, or if heart problems run in your family. Add two from the specialist guidance: palpitations brought on by exercise rather than by rest, and any family history of sudden death at a young age. That is a routine appointment, not an emergency one.

One practical thing. Episodes are usually over long before anyone gets a tracing, and a rhythm recorded during symptoms is the strongest evidence there is. So if you feel well, it is settling, and it has never been captured, that is a reason to be seen soon rather than in a fortnight. If it will not stop, or any of the symptoms above are with it, that is the 999 route and not this one.

When you have been checked and are still checking

There is a version of this that is not about the heart any more. The tests were normal, you believe it, mostly, and you still take your pulse in the car park. The NHS lists compulsive checking among the behaviour changes anxiety causes. And checking, in my experience, is what keeps the fear supplied with fresh evidence. More on that loop in health anxiety and the checking cycle.

If that is where you have ended up, the thing needing attention is the checking rather than the heartbeat, with the standing exception of anything new or different, which still gets looked at. It is a narrow problem with a clear shape, and narrow specific problems are what our 20 minute sessions are built around.

This article is for general information and is not a substitute for personal medical advice. If your heartbeat worries you, get it checked rather than deciding for yourself what it is. If you are in crisis or at risk of harm, contact your GP, call 999 or NHS 111 in the UK, or a crisis line such as Samaritans on 116 123. brightloaf is not a crisis service.