What causes abnormal heart rhythms - and how to tell if it's anxiety or not

Asian woman having problems with heart palpitations or heart beating too fast after drinking coffee and too much caffeine
-Credit: (Image: Getty)


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

We all know our heart rate speeds up 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?

So is it stress and anxiety, or could it be a problem with your heart? This is what you need to know.

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 palpitations?

Asian woman having problems with heart palpitations or heart beating too fast after drinking coffee and too much caffeine
It's common for people to have palpitations when they're anxious -Credit:Getty

"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.

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Nippoda explains that it's common for individuals suffering from 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 elaborates.

So how can you determine if anxiety is impacting your body?

If stress or anxiety is the cause, there will likely be a few other signs as well. "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," Nippoda points out.

You may also feel generally tense and on edge, possibly appearing more impatient and irritable and finding it hard to relax. Sometimes, it's quite clear that you're under pressure and have a lot on your mind, although anxiety doesn't always have an obvious external trigger.

Always seek medical advice

However, as Nippoda notes: "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 symptoms of the heart, it's always best to get things properly checked out sooner rather than later. This is a sentiment echoed by Dr Oliver Segal, consultant cardiologist and electrophysiologist at The Harley Street Clinic, part of HCA Healthcare UK.

elder heart attack chest paint for background with space for text
Always seek medical advice -Credit:Getty

"While palpitations 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," Segal advises.

This is particularly important if you're experiencing additional physiological symptoms.

"If you also feel breathless, have chest pain or feel faint, dizzy or pass out, then these are all potential red flags," Segal warns. "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 do doctors diagnose and treat arrhythmia?

Your GP will typically begin by inquiring about your symptoms and medical history, as well as examining your heart, pulse, and blood pressure. Segal notes that certain tests are crucial for identifying heart rhythm disorders: "Usually, an ECG, echocardiogram (ultrasound scan of the heart), ECG monitor (often a patch monitor), and blood tests are needed."

Fluorographic image of the lungs on paper close-up and a cardiogram on paper, healthy human lungs for a routine examination
Your GP will typically begin by asking you about your symptoms and medical history -Credit:Getty

Among the common types of arrhythmia are atrial fibrillation (AF), which leads to a fast, irregular heartbeat and is more common in older individuals, and supraventricular tachycardia (SVT), which triggers the heart to beat much faster intermittently. Another condition, heart block, is characterised by a slower than normal heart rate, which may also be irregular.

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."

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