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Palpitations: Anxiety or Heart Disease?

Is anxiety or heart disease making your pulse race?

This post is in response to
A Human Life Is Not a Problem to Be Solved

In his thoughtful post, Dr. Steven Hayes discussed (among other things) an episode in which he felt his heart race. Feeling your heart race, or palpitations, is a very frequent symptom of anxiety. On the other hand, certain types of palpitations are a signal of heart disease. How can we tell whether palpitations represent a symptom of anxiety or heart disease? And finally, when one has palpitations from anxiety, what are some very practical steps to address them?

A study in the Archives of Internal Medicine looked at 107 consecutive patients with a heart rhythm problem called "paroxysmal supraventricular tachycardia" or "PSVT." [Lessmeier,, Archives of Intern. Med. 1997; 157:537-543] With PSVT, the heart rate suddenly jumps to a very high rate. In the above study, the diagnosis of PSVT was missed in 55% of the initial medical evaluations. It is important to properly diagnose PSVT, since its treatment is different than the treatment of anxiety disorders.

To be on the safe side, a resting heart rate going much above 100 (or below 50) may warrant a medical evaluation. In general, a resting pulse of 160, like Dr. Hayes had, would make the diagnosis of a heart rhythm problem fairly likely. I have seen circumstances in which someone has an episode of PSVT that so unnerves him that he then has a panic attack. The extra adrenaline from panic attack, in turn, can worsen the PSVT. Therefore, it's not infrequent that a combination of PSVT and panic disorder can occur, and for the best health care, both conditions should be diagnosed and treated.

In addition to a very fast or slow pulse, there are a couple of other signs/symptoms that should signal the need for a cardiac evaluation:

  • Chest pain or shortness of breath (can happen in panic disorder, but cardiac evaluation should be done as a precaution).
  • A very irregular heart beat. An occasional missed or extra beat is usually not a big deal. But if you don't have any consistent rhythm, a condition called "atrial fibrillation" is possible.

If palpitations are bothering you a lot, a chat with your doctor is worthwhile. Even if the palpitations are from anxiety, you now have some extra reassurance. If you have been evaluated medically and there is no sign of a cardiac rhythm problem or other medical condition (such as a high thyroid hormone level), what do you do then?

Let's look at the common way in which one might deal with anxiety and palpitations. If you don't like the palpitations and anxiety, it seems quite natural to resist your feelings and push them away. Common approach... yes;! The more you wish your heart rate would slow done, the faster it goes. In essence, you're getting anxious about being anxious. If you want to make it even worse, you can come up with all the reasons that you could be anxious. Listing and ruminating about all your problems is another way to get that heart pumping even faster.

What's the alternative? Allow your heart to race as fast as it likes. Without judging or resisting your thoughts, simply let go of the thoughts wishing your heart would slow down. If those thoughts come back 100 times, just gently let them go 100 times... no big deal. Instead of resisting the anxiety, enjoy the feeling of the energy coursing through your veins. Place your full attention and focus on a present moment sensation like your breath. Focus on your abdomen expanding with the in breath and contracting with the exhalation. Really taste or luxuriate in the sensation of each full inhalation and each exhalation. Perhaps tune into your body. With each exhalation you can let one of your muscle groups relax. Relax your neck, your jaw, your face, your shoulders, etc. By accepting your current feelings and tuning in to the present in this way, your palpitations will likely pass much more quickly. (And of course, if they are needed, there are a variety of both pharmacological and non-pharmacological treatments for anxiety disorders.)

For more detailed info you can check out Take the Stress Out of Your Life.

Wishing you much peace, health, and happiness!