ANXIETY & STRESS
Heart Palpitations During a Panic Attack: What to Do
A panic attack may trigger adrenaline-related racing and pounding, but a first episode or concerning symptoms still needs medical evaluation.
Written by: Dr. Albana Greca, MD, MMedSc, Family Physician, IDF Fellow
Cardiology specialist profile: Dr. Benard Shehu — medical review pending
Quick Answer
A panic attack may trigger adrenaline-related racing and pounding, but a first episode or concerning symptoms still needs medical evaluation.
Key Medical Takeaways
- Anxiety-related symptoms and arrhythmias can overlap.
- An ECG captured during symptoms can clarify the rhythm.
- Recurrent or unexplained episodes should not automatically be labeled anxiety.
- Chest pain, fainting, collapse or severe breathlessness require emergency care.
Why does panic affect the heartbeat?
Activation of the sympathetic nervous system increases heart rate and may make each heartbeat more noticeable. Fast breathing and muscular tension can add discomfort.
What can help during an episode?
Move to a safe place, sit, and try gentle unforced slow breathing. Avoid breathing into a paper bag. If previously assessed, follow your clinician’s agreed panic-management plan.
When is it not safe to assume panic?
Chest pain, fainting, severe breathlessness, exertional symptoms or a sustained unexpected rhythm should not be dismissed as panic.
How can recurring episodes be managed?
A clinician can evaluate cardiac causes and consider evidence-based treatments for panic disorder, including cognitive behavioral therapy when appropriate.
Emergency Warning Signs
Seek emergency medical attention for palpitations accompanied by chest pain, fainting, collapse or severe shortness of breath. Do not drive yourself if feeling faint.
Frequently Asked Questions
Can anxiety and a heart rhythm problem happen together?
Yes. Having anxiety does not exclude an arrhythmia, and symptoms should be assessed according to risk.
Can an ECG be normal between episodes?
Yes. Short recordings may miss intermittent rhythm changes. A clinician may recommend extended monitoring.
Related Reading
References
This page is educational and does not substitute for individual medical assessment.
Further Clinical Guidance
Understanding the panic–palpitations cycle
Rapid heartbeat can increase fear; fear and adrenaline may then increase the heartbeat further. Naming this pattern can help, but it should not be used to dismiss unfamiliar, severe or exertional symptoms.
Grounding without unsafe breathing techniques
Sit in a safe place, relax the shoulders and breathe gently without forcing deep or rapid breaths. Try observing your surroundings and focusing on a neutral task. Paper-bag rebreathing is not recommended because it can be dangerous when symptoms have another cause.
What helps recurrent panic symptoms
If a clinician has assessed medical concerns, cognitive behavioral therapy and other evidence-based interventions can reduce recurrent panic symptoms. Discuss medication options and possible cardiac side effects with the treating clinician.
For further evaluation, see our guide to ECG, Holter monitoring and normal results.
Related guide: Anxiety, Stress & Heart Palpitations — Complete Guide.