Does anxiety make your heart race? Try these simple tricks to find calm.

I can feel my heart beating quickly when I’m feeling anxious or stressed. What can I do about it? Is this normal?

You can slow a rapid heart rate, caused by anxiety and even cardiac arrhythmias, using a classic technique called vagal maneuvers. These are simple actions that engage the vagus nerve — the major nerve connecting the brain to your internal organs.

There are two main options I recommend:

- The straw trick: Place a straw in your mouth and pinch the other end closed. Blow for about 15-20 seconds. If you don’t have a straw, place your finger in your mouth and blow against it as if it were a straw. The technique is one example of a “Valsalva maneuver” — named after the Italian physician who discovered it.

- The diving reflex: Fill a bag with ice, hold your breath and place the bag on your face for 20-30 seconds — or as long as you can comfortably hold your breath. Make sure the coldest areas hit your eyes, sinuses and nose. If you don’t have ice, use a bag of frozen vegetables, or fill a bowl with chilly water and immerse your face — it’s just a little more messy that way.

The vagus nerve is responsible for easing us into “rest and relaxation” mode — as opposed to sympathetic nerves that drive a “flight-or-fight” response. In the case of a Valsalva maneuver, increasing pressure in the chest cavity causes your blood pressure to rise. This elevation is detected by sensors in your major blood vessels, triggering a reflex to try to decrease that pressure. The way your body does that is to increase vagal nerve activity, which, in turn, slows down your heart rate.

Vagal maneuvers have up to a 54% success rate in returning the heart rate to normal, but they are typically not considered long-term solutions.

Getting the right evaluation and treatment for a racing heart is critical. There are many causes of an abnormally racing heart that can be explored with your physician, such as arrhythmia or dehydration. Atrial fibrillation, as another example, affects more than 2 million Americans. POTS, or postural orthostatic tachycardia syndrome, which we’re seeing more and more of since the onset of the covid-19 pandemic, tends to affect younger women who may have joint hypermobility or autoimmune disease. Also, a hyperactive thyroid, anemia such as from iron loss, and caffeine can all elevate your heart rate.

Is it normal for my heart to race sometimes?

It’s normal for your heart to race when you’re frightened or stressed — it could be that you’re about to give a speech at your brother’s wedding, or you’ve been called out by your boss during a meeting after you spaced out.

But sometimes people’s hearts start to race for no apparent reason. This is never normal. In fact, I’ve seen numerous cases where people get told this is an anxiety problem and no further cardiac studies are ordered.

A study of over 100 patients with an arrhythmia, or abnormal heart rhythm, called supraventricular tachycardia found that more than half of all patients had initially met with a physician who did not recognize their symptoms as being from the condition. Women were, unfortunately and not surprisingly, twice as likely as men to be told the problem was “psychiatric.”

Panic attacks are common: At least 11% of American adults experience one each year. These attacks can look very similar to supraventricular tachycardia: lightheadedness, sweating, nausea and heart racing. And the hallmark symptom of supraventricular tachycardia is a sense of “impending doom” — much like what occurs with a panic attack.

To make matters worse, living with an unpredictable heart rhythm may well aggravate any underlying anxiety. In fact, while 67% of people with supraventricular tachycardia would technically meet criteria for a panic disorder, that percent plummets to 4% after they undergo appropriate treatment for their cardiac issue.

How do you know if your heart is beating normally?

At rest, your heart rate should be between 60 and 100 beats per minute (it may be even lower if you’re an athlete). People who have an abnormally fast heart rhythm, such as supraventricular tachycardia, tend to have heart rates in the range of 150 to 250 beats per minute.

Knowing how to find a pulse is an important skill because it allows you to measure a heart rate in a pinch.

The easiest places to find a pulse are either the brachial artery (in your wrist) or the carotid artery (in your neck). Personally, I tend to find the carotid more readily palpable — that’s the one TV detectives check when they walk in on a murder scene, right before sadly shaking their heads.

Here’s what to do:

- Use the pads of your index and middle finger — not your thumb, which has its own pulse and can confuse you. Slide two fingers to either side of your windpipe around the level of your Adam’s apple.

- We have a large muscle on both sides of the neck called the sternocleidomastoid that forms the hypotenuse of a triangle with your windpipe and jawline. As you slide your fingers gently to the side of the windpipe, feel for when they hit that diagonal muscle — you want to keep your fingers in the center of the triangle to find the carotid.

- You’re looking for two things: the rate and whether your heart rate is “regular” — meaning the pulses are coming at even intervals — or “irregular,” meaning the intervals between pulses are scattered all over the place.

- Count your heartbeats for 15 seconds and then multiply by four to get a rough estimate — I’ve been in emergency situations manually measuring a pulse, and believe me, you will lose count trying for the whole minute if things are too chaotic.

What I want my patients to know

Rapid electrical activity in your heart doesn’t always translate into palpable pulses, so the number you count doesn’t always give you the whole picture. Talking to a physician and getting a proper evaluation is important to making a diagnosis. Your doctor may order an EKG, or electrocardiogram, taken at the time you’re feeling symptoms.

Sometimes people with abnormal rhythms don’t feel their heart racing, as often happens with atrial fibrillation (smart devices are improving their ability to alert users to this possibility). In these and many other cases, your doctor may want you to wear a heart monitor at home for a few days or weeks that can catch the abnormal rhythm if and when it occurs unexpectedly.

Trisha Pasricha is a physician and journalist who writes the Ask a Doctor column for The Washington Post. She is an instructor of medicine at Harvard Medical School.