Heart palpitations: Is my heart racing from anxiety or arrhythmia?

Heart palpitations. Chest pain. Sweating. A strange fluttering sensation in your chest. These are common symptoms of anxiety or a panic attack, but they are also signs of a dangerous heart condition called atrial fibrillation (AFib), the most common type of arrhythmia, or irregular heartbeat.

Although we all experience moments of heightened stress or excitement—when our hearts seem to “skip a beat”—it’s important to recognize when what you’re feeling is something more serious.

How to tell if it’s anxiety or AFib causing your heart palpitations

When it comes to heart palpitations, where your heart feels like it’s pounding, fluttering or beating irregularly, it can be hard to pinpoint the cause. To make it even harder, an episode of atrial fibrillation can actually trigger a panic attack, or vice versa.

But there are some key differences between the two.

Heart palpitations from AFib

Palpitations due to an arrhythmia are often accompanied by other alarming symptoms such as chest pain or shortness of breath. These symptoms can indicate that your heart isn’t pumping effectively and are a good reason to talk to your doctor.

Symptoms of atrial fibrillation can vary, and some people have no symptoms. The most common symptoms include:

• Heart palpitations
• Fatigue
• Shortness of breath
• Chest pain (angina)
• Lightheadedness

Arrhythmia-induced palpitations usually occur at random times, even when you’re calm or asleep. They may also seem erratic or last a long time.

Heart palpitations from anxiety

If you notice your heart racing or fluttering during or after a stressful event, anxiety might be the culprit. Situations like public speaking, a tight deadline at work, or even worrying about your health can trigger anxiety or a panic attack and cause palpitations.

Anxiety-induced palpitations often come with other symptoms like:

• Shortness of breath
• Sweating
• Trembling
• Dizziness
• Feeling of panic

Palpitations that ease up when you relax, breathe deeply or distract yourself are often anxiety-related. If your heart rate returns to normal once the stressful situation passes, this is another sign that anxiety is the likely cause. Anxiety palpitations typically don’t cause chest pain, fainting or extreme fatigue.

Using wearables to monitor irregular heartbeat

When it comes to telling the difference between AFib and anxiety, technology is your friend. Technological advancements are making it easier for you to keep track of your own heart rhythm. Sensors connected to the newer models of smartphones and smartwatches can monitor your heartbeat and notify you when something seems off. I’ve actually seen these devices discover hidden heart problems in some of my patients.

You can also make use of the heart rate monitor on a home blood pressure cuff or pulse oximeter. Using an objective monitor can help you determine if your symptoms are from anxiety or truly from an AFib episode.

When to see a doctor for heart palpitations

While occasional palpitations caused by anxiety are usually harmless, it’s important to consult a healthcare provider if you’re unsure about the cause, especially if:

• The palpitations are new or have changed in pattern or intensity
• You experience other symptoms like chest pain, fainting or shortness of breath
• You have a history of heart disease or other cardiovascular conditions

Your doctor may recommend diagnostic heart tests like an electrocardiogram (ECG) or a Holter monitor to assess your heart’s rhythm and determine whether an arrhythmia is present.

While the symptoms of anxiety and irregular heartbeat can be confusingly similar, don’t let that keep you from voicing your concerns. Untreated AFib can lead to more serious health conditions such as shortness of breath, fatigue, heart failure or stroke, and getting evaluated early can help you start treatment sooner.

Whether your symptoms are due to AFib or anxiety, you don’t have to face it alone. Book an appointment with a primary care doctor today.