What's the Cause of Palpitations in Anxiety Disorder?

1. Your Heart Isn't Broken

“My heart is beating too fast.”
“My chest suddenly pounds, and it scares me.”
“Could it be arrhythmia?”
“I'm afraid I might die.”

We often hear these words at the clinic. However, ECG, ultrasound, blood tests — all normal. Yet, the anxiety doesn't decrease. Why is that? Perhaps the heart isn't broken, but rather trapped in a sensory loop that the body remembers.

2. Palpitations Are a Physiological Response — But It Doesn't End There

It's natural for the heart to beat. It beats when you exercise, when you're excited, and when you're scared. However, in anxiety disorders, a simple chest palpitation is interpreted as a threat signal. That is, the body reacts, the brain detects it, and that sensation is then misinterpreted as "this is dangerous." When this repeats, thoughts like these arise:

“Is something terrible going to happen?”
“Why is this happening? It's starting again.”

And at that moment, the heart beats even faster. This isn't just a simple emotion. Sensation → Interpretation → Amplification of sensation creates a self-reinforcing loop.

3. The Loop Doesn't Stop on Its Own

Normally, tension subsides over time. But it's different once you enter an anxiety loop. The heart beating isn't a result of emotion, but rather fuel for the emotion. That sensation becomes increasingly sensitive, the brain perceives it as a stimulus, and the stimulus, in turn, evokes a reaction. At some point, a person isn't anxious because of their thoughts, but rather reacting in the way their body remembers. It won't stop by convincing the brain. If you can't control the sensation, your thoughts will follow that sensation.

4. Indenolol Bypasses the Loop by Blocking Sensations

That's why some people take Indenolol. Indenolol is a beta-blocker. It lowers heart rate, reduces tremors, and suppresses sympathetic nervous system expression. When taken before an exam, a presentation, or a performance, it provides remarkable stability. With less bodily reaction, sensations are less stimulated, and the loop doesn't cycle. However, this is merely a medication that blocks expression. It doesn't act on the anxiety loop itself, especially on "how I interpret the sensations I feel." Therefore, while Indenolol is effective for short-term stability in clear situations, it has limitations in redesigning the loop.

5. Acupuncture and Herbal Medicine Lower the Sensitivity of the Sensation Itself

So what about acupuncture or herbal medicine? These methods don't change thoughts in the brain like CBT. Instead, they change the sensations the body feels. Acupuncture lowers sympathetic overactivity, stimulates the vagus nerve to improve HRV, and reduces overall body tension. Herbal medicine stabilizes gastrointestinal function, alleviates palpitations, chest pounding, insomnia, and tremors, acting in a bottom-up manner to prevent the sensory loop from operating too sensitively. This isn't about convincing thoughts, but a method that reduces the overall sensitivity of the circuit by preventing the body from reacting.

6. Strategies to Break the Loop: Top-Down and Bottom-Up

Ultimately, to break this loop, we must simultaneously break the link between sensation and interpretation. This means not trying to forcibly eliminate sensations, but enduring them, examining the interpretation that these sensations are dangerous, not avoiding them, maintaining activity, and sometimes receiving help to alleviate the body's reactions itself. CBT reconstructs thoughts, Indenolol blocks sensory expression, and acupuncture and herbal medicine relax the response loop. Ultimately, all these point in 'one direction'.

The work of simultaneously informing the body and brain that 'this is not dangerous'.

7. Anxiety Is Not an Emotion, But a Circuit

Chest palpitations are not a signal that we have become anxious, but rather part of the sensory loop that creates anxiety. To stop it, we need to adjust all three: the way we interpret that sensation, the way that sensation is created, and the way we react to that sensation. Anxiety is not an emotion. It's a reaction. A circuit. A habit. And circuits can be rewritten.

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