Is Your Pounding Heart Anxiety or AFib?

Medically Reviewed by James Beckerman, MD, FACC on September 03, 2023
3 min read

Your heart feels like it’s racing or skipping beats. There are many reasons that this can happen. You may have just gotten some good news and you’re excited. It could be that you’re about to start a new job and you’re nervous. Or maybe you drank too much coffee this morning and now you have caffeine jitters.

An irregular heartbeat may also be something more serious: a condition called atrial fibrillation, or AFib. AFib is a heart rhythm disorder, or arrhythmia, in which electrical signals in your heart don't travel the right way. It’s like a miscommunication that causes your heart’s two upper chambers (atria) to beat too fast.

AFib symptoms include:

  • A skipped heartbeat followed by a thump
  • Heart palpitations or a fluttering sensation
  • Sweating
  • Chest pain
  • Dizziness
  • Fatigue and weakness

Those symptoms are much like what you might feel if you have anxiety. Either way, they can be scary, and you should call your doctor right away. The condition can start at any age.

How can you tell if you’re having AFib or an anxiety attack? It’s a good question. Studies show that stress and anxiety can worsen symptoms of AFib, but more research is needed to find out if people with anxiety and depression are at greater risk for developing it. Research also shows that people with AFib are more likely to get depression or anxiety because the condition affects your quality of life.

Your doctor will use a few tests to diagnose AFib

  • An electrocardiogram (EKG or ECG) records electrical activity in your heart. It’s a painless test that takes just a few minutes. You lie down and a nurse or technician places electrodes on your skin that measure electricity. If you have an episode of AFib at this time, the test will record it.
  • A heart monitor can detect less frequent irregular heartbeats. Your doctor may suggest you wear one for a few days to try to capture AFib episodes. It’s basically a small, portable EKG.

If your AFib incidents are few and far between, your doctor may suggest you wear an event monitor. An irregular heartbeat will activate the monitor to record the incident. Some activate themselves, and others you have to activate.

  • A stress test may help diagnose AFib if exercise triggers the condition. For this, your doctor may have you run on a treadmill while you wear a heart monitor.
  • A blood test can help rule out other causes for your symptoms, such as a thyroid problem.
  • A chest X-ray will help your doctor see the condition of your heart and lungs. An X-ray also can help rule out other conditions.

Sometimes AFib patients have no symptoms, so the issue goes undiagnosed. But it is treatable and, in some cases, curable. Left untreated, it can lead to heart failure and stroke.

When you talk with your doctor, ask these questions if you think you may have anxiety or AFib.

If you suspect anxiety:

  • Could my anxiety be related to my physical health?
  • Should I see a mental health specialist?
  • Do I need counseling or medication?
  • What can I do at home to feel less anxious?
  • Are there foods or drinks I should avoid?

If you suspect AFib:

  • Which type of AFib might I have: paroxysmal, persistent, or permanent?
  • What’s the cause?
  • Are there foods or drinks I should avoid?
  • What kinds of activities or exercise are safe?
  • What activities or exercises should I avoid?
  • Do I need to have a procedure or surgery?
  • Do I need to take medication?
  • What are the next steps?