A racing or pounding heart is one of the most common physical signs of anxiety. The NHS says palpitations are common and usually harmless, and lists stress and anxiety among the common causes. Caffeine, alcohol, nicotine, lack of sleep and some medicines are others.
Anxiety is not the only cause, though. Less often, a racing heart comes from an overactive thyroid, iron deficiency anaemia or a heart rhythm problem. The NHS also says most panic attack symptoms can be symptoms of other conditions.
So the honest answer is that you cannot always tell from the feeling alone. Palpitations with chest pain, breathlessness or fainting need emergency help. Palpitations that keep coming back need a GP check, usually including a simple heart tracing (ECG).
Get help now
Call 112 or 999 in Ireland, 999 in the UK or 911 in the US if:
Do not drive yourself to the emergency department. Ask someone to drive you, or call for an ambulance.
If those symptoms have stopped, ask your GP surgery for an urgent appointment. In the UK you can also call 111.
See a GP if:
If you are having thoughts of suicide or self-harm: in Ireland, freephone Samaritans on 116 123 or text 50808. In the UK, call Samaritans on 116 123 or NHS 111 and choose the mental health option. In the US, call or text 988.
The HSE explains that anxiety and fear cause your body to release hormones like adrenaline. This can make your breathing and heart rate increase. It is part of the body's "fight, flight or freeze" response to stressful or dangerous situations.
With panic disorder, the HSE says that response may be triggered when it is not needed. That is why a panic attack can happen with no obvious threat.
The NHS lists a "faster, irregular or more noticeable heartbeat" among the physical symptoms of anxiety. The HSE lists "a strong, fast or irregular heartbeat". So a racing heart, a thumping heart and the odd skipped beat can all happen with anxiety.
The HSE says signs of anxiety can be mistaken for a physical illness. It advises talking to your GP if you are concerned.
The NHS describes palpitations as your heartbeat becoming more noticeable. You may feel it in your chest, neck or throat. It may feel like it is:
They can last seconds, minutes or longer.
None of these rules out a heart problem. But they fit the NHS and HSE descriptions of anxiety and panic.
The NHS says panic attacks are frightening but not dangerous. It says an attack will not cause you any physical harm.
The HSE heart attack page carries an important warning. It lists "an overwhelming sense of anxiety (like having a panic attack)" as a possible heart attack symptom. It also says some people have no chest pain at all, especially women, older people and people with diabetes.
So feeling anxious does not prove the cause is anxiety. These features are reasons to get checked, using the box above for how urgently:
The NHS lists these common causes of palpitations:
Palpitations can also come with the menopause or pregnancy.
On caffeine, the US Food and Drug Administration (FDA) lists an increased heart rate and palpitations among the signs of too much. It cites 400 mg a day as an amount not generally linked to negative effects in most adults. It says people vary widely in how sensitive they are.
An overactive thyroid. The NHS lists nervousness, anxiety and irritability among its symptoms. It also lists an irregular or unusually fast heart rate. A blood test can often show whether a thyroid problem is the cause. See our guide to the thyroid function test.
Iron deficiency anaemia. The NHS lists noticeable heartbeats among its symptoms. A blood test can check for it.
Heart rhythm problems. The NHS says these happen when there is a fault with the heart's electrical system. Having palpitations does not necessarily mean you have one. Some types:
The HSE suggests checking your pulse as a useful first step if AF is a possibility. It advises:
The HSE says a normal resting heart rate is 60 to 100 beats a minute. Note whether the rhythm feels steady or irregular. A pulse check cannot diagnose anything, but it is useful to tell your GP.
The NHS says a GP will ask about your symptoms, how often you get them and how long you have had them. They may examine you to rule out other conditions. It helps to note:
Tests that might follow:
You may be referred to a heart specialist (cardiologist). The NHS says palpitations often do not need treatment.
The NHS describes health anxiety as worrying so much about being ill that it starts to take over your life. It says anxiety itself can cause a racing heartbeat, and you may mistake this for illness. Signs include constantly checking your body, seeking reassurance and worrying that tests missed something.
If palpitations come with sudden waves of fear, read about the difference between a panic attack and panic disorder. If the anxiety seems to come from nowhere, see feeling anxious for no reason.
If palpitations are not caused by a health condition, the NHS says avoiding triggers can help. It names stress, smoking, caffeine and alcohol.
During a panic attack, the NHS suggests staying where you are if possible and breathing slowly and deeply. Remind yourself that the attack will pass. The HSE suggests breathing in through your nose and out through your mouth, counting from 1 to 5 on each breath.
For anxiety that keeps returning, the NHS says talking therapies such as cognitive behavioural therapy (CBT) and medicines are the main treatments for panic disorder. We compare the evidence in what actually works for anxiety.
In Ireland, freephone Samaritans on 116 123 or text 50808. Our guide to getting help in a mental health crisis in Ireland explains each option. In the UK, call Samaritans on 116 123 or NHS 111. In the US, call or text 988. In an emergency, call 112, 999 or 911.
Yes, it can feel that way. The NHS lists a "faster, irregular or more noticeable heartbeat" among anxiety symptoms. An irregular pulse can also be a sign of atrial fibrillation, so mention it to your GP.
The HSE says you are unlikely to be admitted to hospital for a panic attack on its own. But if you are not sure it is panic, or you have chest pain, breathlessness or fainting, call 112, 999 or 911.
The NHS says panic attacks are frightening but not dangerous, and will not cause you any physical harm. That applies to panic, not to unexplained symptoms. Get new or different symptoms checked.
A resting ECG only records a few minutes. The HSE says an ambulatory ECG may be used if symptoms come in short, random episodes. Go back to your GP if things change.
This article is general information, not medical advice. It cannot tell you the cause of your symptoms. Talk to your GP about your own symptoms, and before starting, stopping or changing any medicine.
Reviewed by: Proco Team
Last updated: November 2026