Educational reference
About this symptom
An awareness of the heart pounding, racing or skipping is among the most commonly reported sensations during a panic attack, and often the most frightening.
The sensation is real. During intense fear the body's stress response raises heart rate and the force of each beat, which makes the heartbeat noticeable in a way it usually is not. Once noticed, it tends to be monitored, and attention alone can make it feel stronger.
This is where a cycle can form: the sensation is interpreted as a sign that something is medically wrong, that interpretation raises fear, and fear increases the sensation. Psychological treatment for panic often works directly on this loop rather than on the heartbeat itself.
Palpitations also have physical causes, including thyroid conditions, anaemia, some medications, caffeine and stimulants, and cardiac conditions. New, severe, or unusually persistent palpitations should be assessed by a health professional. Panic is not a diagnosis to reach by assumption, particularly the first time.