You're in the kitchen doing the dishes, waiting for a bus, or even preparing for bed, and suddenly your heart starts pounding and racing.
We all know that our heart rate can increase slightly during intense exercise or jump momentarily when we're startled - but what if you're experiencing palpitations without any apparent reason? Could it be stress and anxiety, or might it indicate a heart problem?
Arrhythmia, the medical term for an abnormal or irregular heart rate or rhythm, is linked to various potential conditions, some of which can be quite serious and require monitoring and treatment. Here's what you need to understand.
Can anxiety trigger palpitations?
"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, a psychotherapist and spokesperson for the UK Council for Psychotherapy (UKCP).
This is due to the body's 'fight or flight' response, which can occur during moments of acute stress, leading to a surge in cortisol and adrenaline levels, reports Gloucestershire Live. These stress hormones can trigger several physiological responses, including a sudden increase in heart rate a built-in survival mechanism that prepares us to act quickly.
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Ideally, this is just temporary and things return to normal. However, when people are dealing with ongoing or chronic stress and anxiety, that heightened state can persist. 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 adds.
So how can you determine if anxiety is impacting your body?
If stress or anxiety is the cause, there will likely be 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 said. 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 says: "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.
"While palpitation 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," says Segal. This is especially the case if you're also experiencing other physiological symptoms.
"If you also feel breathless, have chest pain or feel faint, dizzy or pass out, then these are all potential red flags," says Segal. "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 is arrhythmia diagnosed and treated?
Your GP will usually start by asking about your symptoms and history, as well as listening to your heart and checking your pulse and blood pressure. Segal explains that specific tests can help detect heart rhythm issues: "Usually, an ECG, echocardiogram (ultrasound scan of the heart), ECG monitor (often a patch monitor), and blood tests are needed."
Common arrhythmia conditions include atrial fibrillation (AF), which causes an abnormally fast, irregular heartbeat and is particularly likely in older age groups, and supraventricular tachycardia (SVT), which causes the heart to suddenly beat much faster for bursts lasting a few minutes to several hours. Heart block, meanwhile, is associated with an abnormally slow heart rate, sometimes also with an irregular rhythm.
Treatments for heart conditions can vary greatly depending on the type and severity of the condition. This could range from medication and pacemakers to procedures such as catheter ablation, which involves inserting a thin tube via a vein or artery to correct issues with the heart's electrical signals.
Not all arrhythmias are serious, but some, like AF, are associated with a significantly higher risk of stroke and heart attack. "Early diagnosis and treatment can often prevent this," says Segal.
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"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."
If underlying heart problems are ruled out and stress/anxiety is causing your palpitations, getting the right advice and support can make a big difference. Breathing exercises can provide quick relief, while long-term support with talking therapies and sometimes medication may also be beneficial.
The bottom line is, 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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