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Regular Anxiety and Irregular Heartbeat

Daniel Sher, MA, Clin Psychology
Regular Anxiety and Irregular Heartbeat

Many people with severe anxiety experience symptoms that create more anxiety. For example, a person with anxiety may start to breathe differently, and this can cause hyperventilation, which in turn causes chest pains, lightheadedness, and other powerful symptoms that create more fear.

This cycle can occur with many different anxiety symptoms, but is especially common when the heart is involved. When your heart suddenly feels as though it's not beating normally, it can cause significant fear and discomfort. But anxiety itself can cause your heart to skip beats or feel like it’s beating too hard or too irregularly.

Then, this fear can lead you to experience an irregular heartbeat. For those with anxiety, the thoughts that arise in relation to the irregular heartbeat can be extremely frightening, often triggering further anxiety and continuing the cycle.

The question to ask is whether or not these irregular heartbeats - also known as heart arrhythmias - are caused by anxiety and whether or not you need to worry about them. Let’s explore this further. 

Go to the Doctor

Nothing about your heart health should be left to chance. If you haven't already seen a doctor about your heart concerns, schedule an appointment right away to ensure you have no underlying heart problem. Even those whose irregular heartbeats are caused by anxiety may have separate heart issues.

But if the question is whether or not anxiety can cause a heart arrhythmia, the answer is yes - and it's surprisingly common. So common, in fact, that the vast majority of heart arrhythmias are considered harmless when they are linked to anxiety or stress. 

What is an Irregular Heartbeat?

An irregular heartbeat goes by many names. Some people refer to them as heart palpitations. Others refer to it as arrhythmia. Others refer to it as premature ventricular contractions (PVCs). All of these are generally (although not necessarily) referring to the same thing - alterations in the rhythm of your heart. It's also experienced differently by different people. While some may feel like their heart has skipped a beat, others may experience a sudden acceleration and pounding of their heartbeat. 

These symptoms can occur even in the healthiest of people. While PVCs can, in theory, aggravate underlying heart conditions (that's why a doctor's visit is important) and can be caused by factors other than anxiety, they are very often anxiety and stress related. Many are harmless.

Cause of Irregular Heartbeat From Anxiety

Your heart works in mysterious ways, and the truth is that it's not entirely clear why anxiety leads to heart arrhythmia. While there are two causes that are well known (more on that in a moment), there are also times when your heartbeat may simply be altered as a result of the hormones, chemicals, and electrical impulses happening in your body. 

That said, there are two issues that are known to cause an irregular heartbeat. These are:

Adrenaline

When you experience anxiety, your body is essentially in fight or flight mode - an evolutionary adaptation that prepares your body to respond to danger. Anxiety is the faulty activation of this system, causing your fight or flight system to operate even when no danger is present.

During the activation of this system, your body floods with adrenaline. This adrenaline then makes your heart beat faster and possibly alter its beat temporarily to compensate for the change in hormones and prepare your body to fight or flee.

This is one of the most common reasons that people feel irregular heartbeats, and it often occurs when someone is overly sensitive to their heart rhythms or already feeling stress/anxious.

Hyperventilation

The other cause is hyperventilation. Hyperventilation is when you expel too much carbon dioxide because you're either breathing too fast or trying to breathe in too deeply - deeper than you actually need.

Carbon dioxide helps blood move throughout your body. So when your body doesn't have enough Co2, blood flows slower. To get blood flowing faster, your heart needs to beat faster and do more work, and an irregular heartbeat is the result.

Hyperventilation also causes many other symptoms in those with anxiety. For those that have panic attacks, these symptoms may make you feel as though you're suffering from a heart attack, increasing your anxiety and your risk for further heartbeat irregularity. Nevertheless, when these palpitations are caused by anxiety, they are not medically harmful. 

These are only a few of the potential causes of irregular heartbeat. Many people experience an irregular heartbeat when they're thinking about their heart, so it's likely that the brain is also sending certain electrical impulses and neurochemical changes that affect the heart.  Remember, if your heart is in good health, irregular heartbeat caused by anxiety is not dangerous.

The Solution for Irregular Heartbeat

The irregular heartbeat/skipped beat is usually fairly instant. The rapid heartbeat that tends to follow can last anywhere from a few minutes to an hour depending on how you react to it. Panic attacks are often the biggest issue to worry about. If your skipped beat causes a panic attack, it may take you quite a while to feel fully "calm" again.

Because these rhythms can have different causes, there's no one size fits all way of treating it. If it's caused by adrenaline, you simply have to wait for your adrenaline levels to die down and your heartbeat will go back to normal. Once they're in your body they'll only stop when they're used up.

If they're caused by hyperventilation, the key is to simply make sure they don't get any worse. As hard as you can, try not to compensate for your skipped beat by trying to breathe in too quickly or too much to "test" your heart. A very common reaction is taking huge breaths to make sure that your body gets enough air. But these breaths may make hyperventilation worse and cause more anxiety that leads to further symptoms.

In general, when it comes to a rapid heartbeat, the most important thing to do is simply give yourself time to relax. Walking may help a bit to calm you down, but there are otherwise very few things to do to stop the feeling of an irregular heartbeat once it starts. However, if you take steps to treat your underlying anxiety more generally, you’ll be less likely to experience irregular heartbeats in the first place.

Article Resources
  1. Barr, C. Ambulatory heart rate changes in patients with panic attacks. Am J Psychiatry 143.4 (1986): 478-482.
  2. Pauli, Paul, et al. Anxiety induced by cardiac perceptions in patients with panic attacks: A field study. Behaviour research and therapy 29.2 (1991): 137-145. 
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