When to worry about palpitations with panic disorder

During panic, the nervous system enters an alarm state. Adrenaline can make the heart pound, race, or feel uneven, often alongside trembling, sweating, chest tightness, dizziness, and a sense of impending danger. The sensation can be frightening even when it is part of a familiar panic pattern. A diagnosis of panic disorder should not be used to explain away a new pattern, because heart rhythm and other medical problems can produce overlapping symptoms.

Sit or stand in a safe place and loosen tight clothing. Breathe gently and slowly, allowing the exhale to be longer than the inhale; avoid forcing very deep breaths. Remind yourself of the steps in your agreed panic plan and avoid driving until you feel steady. Keep a record of triggers, duration, pulse if advised, medicines, caffeine, and associated symptoms. Do not stop prescribed treatment suddenly without speaking with your clinician.

Call emergency services if palpitations come with chest pressure, collapse, severe breathlessness, weakness on one side, or confusion. Seek prompt medical advice when the rhythm is persistently irregular, occurs during exertion, wakes you repeatedly, lasts longer than your usual episodes, or continues after the panic symptoms settle. Arrange a review for frequent attacks, avoidance of daily activities, or treatment that is no longer helping.

Ask how to distinguish your usual panic pattern from symptoms needing assessment, whether an ECG is suitable, and how to use psychological treatment, medication, sleep, and caffeine changes in your plan.