Palpitations vs Anxiety – When to Get Your Heart Checked

By Dr Nabila Laskar — published March 2025.

Understanding the difference between anxiety-related palpitations and heart rhythm problems that need investigation.

What Are Palpitations?

Palpitations are the sensation of your heartbeat becoming noticeable — racing, fluttering, skipping beats, or pounding in your chest, neck or throat. They can feel alarming but are very common and often harmless. Because they can sometimes indicate an underlying arrhythmia, it is important to understand when they warrant investigation.

Anxiety-Related Palpitations: Key Features

Palpitations are more likely to be anxiety-related when they occur during or after stressful situations or panic attacks; you also have other anxiety symptoms (breathlessness, sweating, trembling, sense of impending doom); the heart rate is fast but regular rather than irregular; episodes resolve when you calm down; and you are under 40 with no personal or family history of heart disease.

When Palpitations Need Cardiac Investigation

Seek assessment if palpitations come with chest pain or pressure, dizziness, lightheadedness or fainting, severe breathlessness, an irregular or chaotic heartbeat rather than just fast, episodes lasting more than a few minutes or occurring frequently, a family history of early heart disease or sudden cardiac death, or known cardiac risk factors (high blood pressure, diabetes, high cholesterol).

How We Investigate Palpitations

Investigation usually combines a detailed clinical history, a baseline 12-lead ECG and — most importantly for intermittent symptoms — a 7-day Holter monitor to capture the rhythm during a real episode. An echocardiogram may be added to exclude structural causes.

Common Causes of Palpitations

Benign causes include anxiety and stress, caffeine, alcohol or stimulants, dehydration, fever, certain medications, and hormonal changes. Cardiac causes include atrial fibrillation (AF), supraventricular tachycardia (SVT), ventricular ectopic beats, valve problems, cardiomyopathy and thyroid disorders.