Can heart palpitations be caused by stress? Learn why your heart races, when to see a doctor, and how to break the cycle of anxiety around your heartbeat.
A tense phone call with your landlord about a rent increase comes to an end. You put the phone down, but your heart does not settle down with it: fast, strong beats in your chest, so loud you can almost hear them in your ears. You place a hand on your chest, then move it to your wrist and start counting your pulse. Heart palpitations under stress are a very common experience; yet in that moment, that is usually not the question that comes to mind. The question that comes to mind is: "What if there is something wrong with my heart?" In this article I explain why and how stress speeds up the heart, which palpitations must always be seen by a doctor, why the fear can persist even when the tests come back clear, and how you can step out of this cycle.
What Are Heart Palpitations, and Does Everyone Mean the Same Thing?
What we call "palpitations" in everyday language actually covers several different sensations. Some people describe the heart speeding up, some describe strong, "thumping" beats, and others describe the heart seeming to pause for a moment and then carrying on with a hard beat. What they have in common is that a heartbeat we normally do not notice enters our awareness.
This distinction matters, because a healthy heart also changes its pace constantly throughout the day. Climbing stairs, after a hot shower, on a full stomach or after the third glass of tea, the heart rate rises. Most of the time we do not even feel it. During anxious periods, however, our attention turns towards the body and the very same beats suddenly become "audible". In other words, sometimes what has changed is not the heart itself but the intensity of the attention we direct at it.
Can Heart Palpitations Be Stress-Related?
Yes, they can, and this is quite common. When your brain perceives a situation as a threat, the sympathetic nervous system kicks in and the adrenal glands release adrenaline. One of adrenaline's first targets is the heart: it contracts faster and more forcefully, so that more blood reaches the muscles. This is a mechanism that has served us for thousands of years in moments when we needed to run or defend ourselves.
The problem is that, in terms of the bodily response, the brain does not distinguish much between a predator and an unpaid credit card statement. A message from your manager saying "Let's talk tomorrow morning", your child's LGS practice exam result (LGS is Turkey's national high-school entrance exam), an argument in the family or news of an aftershock can all set off the same system. Heart palpitations are the most visible and most easily felt part of the stress response; this is why many people notice anxiety first in their heart.
Common companions of stress-related palpitations include:
- Sweaty palms, a dry mouth
- A tightening in the stomach or a "butterflies" feeling
- Faster breathing or a sense of tightness in the chest
- A slight trembling of the hands
- The mind locking onto one issue, difficulty concentrating
Once the stress passes, the heart rate usually returns to normal within a few minutes to half an hour. For someone living under chronic stress, however, the moment "when the stress passes" may rarely arrive; in that case a mild but continuous sense of speeding up can last all day.
Caffeine, Sleeplessness and Hidden Accelerators
Stress rarely comes alone; it usually arrives with helpers. Less sleep during a busy week, skipping lunch and getting by on coffee, an energy drink in the evening or smoking more cigarettes all raise the heart's level of arousal. Some cold remedies, imbalances in thyroid hormone and anaemia can also cause palpitations. That is why reviewing these factors before saying "it's stress" is valuable, both medically and for understanding yourself.
Which Palpitations Should Be Seen by a Doctor?
As a psychologist, this is what I need to say clearly: deciding that heart palpitations are stress-related comes after a medical assessment, not before. If you are experiencing palpitations for the first time, if they are unusual for you, or if they have any of the features below, you need to see a doctor:
- They come with chest pain, or pain spreading to the left arm, jaw or back
- There is fainting, feeling about to faint, or clouding of consciousness
- There are irregular palpitations that do not settle for a long time, even at rest
- Exertion brings marked breathlessness, and your ankles swell
- There is a family history of sudden cardiac death at a young age
If any of these is happening severely, call 112 (emergency services) without delay. A cardiology assessment usually involves an ECG, blood tests and, if needed, investigations such as a Holter rhythm monitor or an exercise stress test. These do not only give you safety; they also lay solid ground for later psychological work. Having heard "your heart is healthy" from a specialist is the foundation for the steps taken in therapy.
The Tests Are Clear but the Fear Will Not Go: Anxiety's Cycle in the Heart
Many people arrive at the clinic with a whole folder of clear results: two ECGs, a Holter, perhaps an exercise test. Even so, the same fear starts all over again with every bout of palpitations. The reason is that fear is fed not by information but by experience.
The cycle works roughly like this: you notice your heartbeat. Your mind interprets it as "something is wrong". This interpretation raises anxiety, anxiety raises adrenaline, and adrenaline raises the heart rate. The faster beat seems to confirm the first interpretation. After a few rounds you may find yourself on the edge of a panic attack. If you would like to see the full picture of panic, the article on panic attack symptoms describes it in detail.
The more you listen to your heart with fear, the more it gives you to fear, because the listening itself speeds up the beat.
The second element that keeps the cycle going is safety behaviours. Constantly taking your pulse, checking the heart-rate graph on your smartwatch, searching the internet for "heart attack symptoms", avoiding stairs, cutting out coffee completely and staying away from exercise as well... These bring short-term relief but send the brain a hidden message: "So there really was danger, good thing we took precautions." In this way, the chance to learn that a faster heartbeat is harmless never arises. If this pattern has started to spread across your health in general, the article on health anxiety may also feel familiar.
What Do Stress-Related Palpitations Look Like in Daily Life?
In Turkey in recent years, people's stress load has grown on many fronts. Worry about making it to the end of the month, haggling over rent and building fees, long working hours and commutes on company shuttles, the responsibility of caring for more than one generation in the family, and the state of high alert left behind by the 6 February 2023 earthquakes all narrow the heart's room to rest. Under these conditions, palpitations often come not from a single event but from an accumulated load.
Let us say an accountant in her thirties is working until midnight during the year-end closing week, eating lunch at her desk and drinking five or six mugs of coffee a day. On Sunday evening, sitting on the sofa, she notices her heart speeding up and this time she is frightened: "There's no stress at all right now, why is it pounding?" Yet the body may be paying a week's bill in that calm moment. The body does not have to recover the instant the stress load drops; sometimes moments of relaxation are the first moments in which the suppressed tension is actually felt.
Someone who experiences palpitations may begin to make the following changes in daily life:
- Avoiding hills or stairs and waiting for the lift
- Wanting their spouse or mother beside them constantly so as not to be alone
- Staying away from crowded wedding halls and hot environments
- Turning taking their pulse before sleep into a nightly ritual
Each of these steps is understandable; but they shrink the space you live in and feed the fear.
There is another common situation as well: the person says, "But I'm not stressed." Indeed, some people feel stress not in their minds but only in their bodies. For someone who is not used to talking about feelings, who grew up with "we'll manage", and who tries to solve problems quietly, the heart may be the first place where the burden finds a voice. In that case it helps to see palpitations not only as a symptom but as a message worth paying attention to. The message is often not "Your heart is broken" but "You have been carrying something for a long time."
What Can You Do During and After Stress-Related Palpitations?
The suggestions below are for people who have had a medical assessment and been told their palpitations are linked to anxiety. The aim is not to make the palpitations vanish instantly, but to stop accompanying them with fear.
In the Moment
- Describe the sensation; do not interpret it. There is a big difference between saying "My heart is beating fast, there are strong beats in my chest right now" and saying "My heart is going to stop." The first is an observation; the second is a prophecy.
- Lengthen your out-breath. Take a calm breath in through your nose and breathe out through gently pursed lips for about twice as long as the in-breath. A long out-breath supports the branch of the nervous system that slows the heart.
- Postpone taking your pulse. Notice your hand reaching for your wrist and say, "If I still need to in ten minutes, I'll check then." Very often the urge fades on its own.
- Go back to what you were doing. Returning to the washing-up, the walk or the email you were writing tells your body, "This is not an emergency."
In the Longer Term
- Reduce caffeine gradually; do not stop all at once, as stopping suddenly can cause headaches and restlessness.
- Bring movement back. With your doctor's approval, brisk walking teaches your body again that a faster heartbeat can also be safe. If you have been avoiding stairs, try climbing one floor first, then two.
- Name the source of stress. Write down in a notebook the days when the palpitations intensify, and look at what was happening on those days. Seeing a pattern takes the blame off your heart.
- Protect your sleep. A sleepless night makes the heart more easily aroused the next day.
- Review your smartwatch notifications. If you keep receiving heart-rate alerts, talk to your doctor about how necessary that feature really is for you.
When Should You Seek Professional Support?
If your medical assessment was clear but one of the following describes you, it may be useful to talk to a mental health professional:
- Fear of palpitations takes up a significant part of your day
- You go from doctor to doctor, having the same tests repeated again and again
- You have given up areas such as exercise, hills, crowds or travel because of palpitations
- Episodes of palpitations come with intense fear of dying, an urge to escape and a sense of unreality
- Your sleep, work or relationships have started to suffer because of this anxiety
These signs do not amount to a diagnosis on their own; but they may show that the anxiety no longer dies down by itself. If the symptoms are very intense, an assessment by a psychiatrist can also be discussed alongside therapy.
If Heart Palpitations Are Stress-Related, How Are They Approached in Therapy?
Cognitive Behavioural Therapy (CBT) is one of the research-supported approaches for working with the fear that accompanies bodily sensations. The process is shaped around the individual, but it usually includes the following steps:
Drawing a shared map. The last few episodes of palpitations are discussed in detail: what was happening, what was noticed first in the body, what went through the mind, and what was done next? This map lets the person see their own cycle from the outside.
Testing interpretations. The belief "If my heart is racing, I am in danger" is examined together with the evidence. How many episodes of palpitations have occurred so far, and how each of them ended, is reviewed.
Exposure to the sensation. With the therapist, and in a controlled way, the heart rate is deliberately raised through exercises such as gentle running on the spot or climbing a few flights of stairs. The person learns by experience that the sensation they fear settles by itself. This step is planned with the doctor's approval and at the person's own pace.
Letting go of safety behaviours. Pulse checking, internet searches and avoidance are reduced step by step.
Returning to the source of stress. The heart is only the messenger. The real burdens, such as burnout, boundary problems in the family, perfectionism or grief, also come onto the therapy agenda. A schema-focused perspective can help in understanding where deep-seated beliefs such as "I must always be on guard" come from.
This work can be done face to face or online. You can read in more detail how anxiety and bodily symptoms are worked with on the anxiety and panic page.
Frequently Asked Questions
Can stress cause permanent damage to the heart?
A short-term stress response is not dangerous for a healthy heart; the heart is designed for these surges. Chronic stress lasting many years, however, is known to be able to affect cardiovascular health negatively. That is why the aim is to address not only the palpitations but also the stress load.
Should I take my pulse when I have palpitations?
Unless your doctor has specifically asked you to, taking your pulse frequently usually increases anxiety. Measuring locks your attention onto your heart and can turn every number into a danger signal. Clarifying with your doctor when you should measure is the healthiest approach.
Is it normal to have palpitations only in the evening or while resting?
At moments of rest, attention turns from the outside world to the body; this is why beats that go unnoticed during the day can become prominent in the evening. The relaxation that follows a busy period can have a similar effect. Even so, if this complaint is new, a medical assessment comes first.
Will therapy help if my palpitations do not go away?
The goal of therapy is not that your heart never speeds up, but that when it does, fear does not run your life. Many people describe noticing palpitations less over time, and finding that when they do notice them, they settle more quickly; whenever you need it, support with this is available.
Bu yazı genel bilgilendirme amaçlıdır; tanı veya tedavi yerine geçmez. Yaşadığınız güçlükler için bir ruh sağlığı uzmanına başvurmanız önerilir. Acil bir durumda lütfen 112'yi arayın.
Eda Erkan Alapala
Klinik Psikolog. İstanbul Kent Üniversitesi Klinik Psikoloji Tezli Yüksek Lisans mezunu; bilişsel davranışçı terapi, çocuk merkezli oyun terapisi ve çocuk-ergen psikoterapisi alanlarında eğitimlerini tamamlamıştır.
Eğitimler
