My Pounding Heart: Is It Anxiety or AFib?

From the WebMD Archives

Today's the big day. Maybe you've got a job interview lined up. Or you're having dinner with your future in-laws for the first time. Suddenly your heart races too fast or feels like it skipped a beat.

It's just the jitters, right? Could be. Sometimes, though, that thumping is a problem called atrial fibrillation, or AFib for short.

So how can you know? Your doctor has the final word, but there's a lot you can learn on your own if you pay attention to your ticker and what it's trying to tell you.

What Does It Feel Like?

"We are not supposed to feel our heart beating, so when we become aware of it, it's usually because something is out of the ordinary," says Elsayed Soliman, MD.

That "something" is what doctors call heart palpitations. You might feel like it's fluttering, pounding, or skipping beats. Or it could seem like it's going too fast.

"Most people have felt it at one point or another, and it's not usually cause for alarm," Soliman says.

Sometimes, there are simple reasons. You might get palpitations if you drink caffeine or take a drug that makes you jumpy, like some cough or cold medicines. A tough workout, dehydration, or illness can also bring them on. So can drinking alcohol or a lack of sleep.

Why Your Frame of Mind Plays a Role

One of the most common causes of heart palpitations is anxiety. If you're nervous or stressed out, your brain releases hormones that can cause your heart to pound.

If anxiety is to blame, you may have some other symptoms too, says Ralph Sacco, MD, like sudden sweating or an upset stomach. You might even feel lightheaded or have trouble breathing.

Sometimes, Soliman says, you might not even realize that you're nervous. For instance, that racing heart you notice when you walk into your office each morning might be triggered by job stress, even if you tell yourself that everything is under control.

Could It Be AFib?

Overall, few palpitations are caused by serious heart conditions. But sometimes they're a symptom of AFib. It could be dangerous if you don't get treatment.


During atrial fibrillation, the upper chambers of your heart have an irregular beat, and quiver like a bowl of Jell-O. Your blood pools there, and it gets harder to pump it out to the rest of your body.

When palpitations are from this condition, they often last longer than those brought on by anxiety. You'll feel them for more than just 1 or 2 seconds at a time.

AFib may also cause lightheadedness, fatigue, chest pain, or a drop in blood pressure. Talk to your doctor about getting tested for a heart problem if you get any of these symptoms with your palpitations. He may want to monitor you with a portable device that records your heartbeats for a few days or weeks.

You're more likely to get atrial fibrillation if you're over 65 or already have a heart or thyroid problem. If that sounds like you, get your irregular heartbeats checked out by your doctor, Sacco says.

How to Decide: AFib or Not?

When you get a heart palpitation, see if you can figure out what the trigger might be. Are you anxious about something? Have you recently had caffeine or a medicine with a stimulant? Too much alcohol? Change your habits or avoid similar situations, and see if your symptoms go away.

If you can't find an obvious reason, look for patterns. Do they happen at the same time of day, or in the same place? This may help you find a hidden cause, or help your doctor make a correct diagnosis.

An occasional heart palpitation, without any other warning signs, probably doesn't need treatment. "But if it starts happening frequently, or you know you have an existing heart condition, it's worth mentioning to your doctor," Sacco says.

WebMD Feature Reviewed by Suzanne R. Steinbaum, MD on June 25, 2015



Johns Hopkins Medicine: "When to Evaluate Heart Palpitations."

Elsayed Soliman, MD, director, Epidemiological Cardiology Research Center at Wake Forest Baptist Medical Center.

Ralph Sacco, MD, chairman of neurology, University of Miami Miller School of Medicine; past president, American Heart Association.

News release, Wake Forest Baptist Medical Center.

American Heart Association. "What Is Atrial Fibrillation?"

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