TL;DR
- •Palpitations are an awareness of your heartbeat — pounding, racing, fluttering, or skipping — and anxiety is one of the most common causes.
- •When you're anxious, adrenaline speeds and strengthens the heartbeat and makes you more aware of it; in panic, this can spike suddenly and feel alarming.
- •Anxiety-driven palpitations are usually benign, but new, severe, or worrying cardiac symptoms should always be medically evaluated to rule out a heart cause first.¹ ²
- •A vicious cycle is common: noticing the heartbeat triggers fear, which releases more adrenaline, which intensifies the palpitations.
- •Once a heart cause is excluded, treatment focuses on the anxiety — and the palpitations typically settle as the anxiety is treated.
- •This page describes the experience, not medical advice. If you have chest pain, fainting, or severe or new symptoms, seek medical care.
What this can look like
- •A pounding or racing heart that comes on with stress, worry, or a panic surge
- •Fluttering or a sensation that your heart "skipped" or "flip-flopped"
- •Becoming hyper-aware of your heartbeat, especially when lying down or quiet
- •Fear that something is wrong with your heart, which ramps the sensation up further
- •Palpitations that ease once the anxiety passes or you're distracted and calmer
Commonly associated with
This is descriptive, not diagnostic. Having this symptom doesn’t mean you have any of these conditions — only a clinician can make that determination.
Panic disorder
A pounding or racing heart is one of the most common and frightening panic-attack symptoms, and fear of it can drive more attacks.
Generalized anxiety disorder
Chronic anxiety keeps the body's arousal system activated, producing palpitations and other physical symptoms.
Health anxiety
Worry that palpitations signal heart disease can amplify body-monitoring and fear, intensifying the symptom.
Self-help patterns
Patterns that may complement professional treatment — not substitutes for it.
- •Get checked first — once a clinician has ruled out a heart cause, you can treat the palpitations as anxiety with more confidence
- •Use slow, paced breathing (longer exhales) to activate the calming branch of the nervous system
- •Cut stimulants — caffeine, nicotine, and energy drinks worsen palpitations
- •Name it — "this is adrenaline, not my heart failing" — to interrupt the fear-adrenaline loop
- •Reduce body-checking and reassurance-seeking, which keep attention locked on the heartbeat
When to seek professional help
- •Always get new, severe, or changing palpitations medically evaluated to rule out a cardiac cause first
- •Seek urgent care for palpitations with chest pain, fainting, severe breathlessness, or collapse
- •Anxiety-driven palpitations are frequent, distressing, or driving avoidance and panic
- •Worry about your heart persists even after a normal medical workup (a sign to treat the anxiety)
Treatment options
After a heart cause is excluded, anxiety-driven palpitations are treated by treating the anxiety. CBT — especially for panic — directly targets the fear of bodily sensations and the catastrophic interpretation ("my heart is failing") that fuels the cycle, often using interoceptive exposure to reduce the fear of the feeling. SSRIs/SNRIs help underlying anxiety and panic disorder. Cutting caffeine and other stimulants, and treating health anxiety where present, also reduces both the palpitations and the alarm around them.
Where ketamine fits
Anxiety palpitations are not a ketamine indication, and a few practical points matter here: ketamine itself can transiently raise heart rate and blood pressure, so cardiac symptoms are always screened and a heart cause excluded before any treatment. The mainstays for anxiety-driven palpitations are CBT (particularly for panic), SSRIs/SNRIs, and reducing stimulants. Where palpitations are part of an anxious, treatment-resistant depression, treating that depression is the broader goal — but the palpitations themselves are best addressed through anxiety-focused care.
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Frequently asked
Can anxiety really cause heart palpitations?
Yes — it's one of the most common causes. Anxiety releases adrenaline, which speeds and strengthens the heartbeat and makes you more aware of it. In a panic attack this can spike suddenly and feel alarming, but it's the body's alarm system, not the heart malfunctioning.
How do I know if it's anxiety or my heart?
You don't self-diagnose this — new, severe, or changing palpitations should always be medically evaluated to rule out a heart cause first, especially with chest pain, fainting, or breathlessness. Once a clinician has checked and found your heart healthy, you can treat the palpitations as anxiety.
How do I stop anxiety palpitations?
Once cleared medically: slow paced breathing, cutting caffeine and other stimulants, naming it as adrenaline rather than danger, and reducing body-checking. For the underlying anxiety or panic, CBT and sometimes SSRIs/SNRIs are highly effective and usually settle the palpitations.
Does ketamine help anxiety palpitations?
It's not a treatment for them — and ketamine can transiently raise heart rate and blood pressure, so cardiac symptoms are screened first. Anxiety-driven palpitations are best treated with CBT (especially for panic), SSRIs/SNRIs, and cutting stimulants.
References
- Barsky AJ et al. 1996, Archives of Internal Medicine. Somatized psychiatric disorder (including anxiety) frequently presents as palpitations. PMID 8638998
- Tunnell NC et al. 2024, Frontiers in Psychiatry. A biobehavioral approach to distinguishing panic symptoms from medical/cardiac causes. PMID 38779550
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