“My chest is pounding.” “My breathing feels shallow and tight.” “Sometimes my heart suddenly skips a beat.” When palpitations or shortness of breath like these continue, the first worry that comes to mind is often, “Could this be a heart problem?” On the other hand, when people actually get tested, it is not uncommon to find no abnormality in the heart at all, with stress or an imbalance in the autonomic nervous system lying behind the symptoms instead.
In my outpatient practice, more people than you might imagine come in after searching for terms like “palpitations shortness of breath stress.” Many cannot tell on their own whether the cause is heart-related or stress-related, and they often struggle even with the question of whether they should see a doctor at all.
In this article, from my standpoint as the director of Keldsen Family Clinic, I have carefully put together an overview of the causes behind palpitations and shortness of breath, easy-to-notice guideposts for telling them apart on your own, the timing at which you may want to consider seeing a doctor, the flow of the tests we can perform at our clinic, and self-care for daily life.
What Kind of Condition Are Palpitations and Shortness of Breath?
The Medical Meaning of “Palpitations”
“Palpitations” refers to a state in which your heartbeat—something you normally do not notice—feels strong, fast, or as though it is skipping. The way people experience them varies: “tachycardia,” in which the resting pulse rises to 100 beats per minute or more; “premature beats,” in which a beat feels as though it has skipped or dropped out; “arrhythmia,” in which the rhythm becomes irregular; and so on.
The Wide Range of Sensations Meant by “Shortness of Breath”
“Shortness of breath” is medically referred to as a sense of dyspnea. It covers a range of expressions, such as the feeling that not enough air is coming in, a sensation of tightness in the chest, or the feeling that you cannot get a satisfying breath even when you take a deep one. As in palpitations shortness of breath stress, the two often occur together as a set, and their causes frequently overlap.
Why It Matters Not to Insist on Judging for Yourself
What matters is not trying to conclude from the very start, entirely on your own, “whether or not something is abnormal.” The attitude of “I’m concerned, so I’ll get it checked just once” is, in the end, the safest approach and the one that leads to the most peace of mind. Even at the stage where you are unsure which department to visit for palpitations, our clinic—which combines Psychosomatic Medicine and Internal Medicine—lets you consult about everything in one place.
The Four Main Causes of Palpitations and Shortness of Breath
When patients consult me about palpitations and shortness of breath in the outpatient setting, the causes can often be organized into four broad categories. You do not necessarily fall into just one; several factors may overlap.
1. Stress and Autonomic Nervous System Imbalance
This is the type I encounter most often. When chronic stress from work, family, or relationships, or a sudden change in environment, throws off the balance of the autonomic nervous system, palpitations and shortness of breath can appear even when the heart itself is healthy.
In some cases, Panic Disorder, Anxiety Disorder, Autonomic Nervous System Disorder, or Adjustment Disorder may be hidden in the background, and left unaddressed, they can become chronic. Many of the people who come in searching for the keyword “palpitations autonomic nervous system” fall into this category.
2. Heart-Related Causes (Cardiovascular Disease)
Although less frequent than the first category, this is a group we never want to overlook. It includes arrhythmia, angina, myocardial infarction, heart failure, and valvular disease. In particular, when palpitations are accompanied by “chest pain with a cold sweat” or “a feeling that you are about to faint,” we respond with the possibility of a heart-related cause in mind. If you would like to check public information about cardiovascular disease, you may also refer to the website of the Japanese Circulation Society.
3. Internal Medicine Conditions (Thyroid, Anemia, Low Blood Sugar, etc.)
Even when there is no abnormality in the heart itself, palpitations can arise from conditions seen in internal medicine. Representative examples include hyperthyroidism (Graves’ disease), iron-deficiency anemia, low blood sugar, infections, and dehydration. Many people search for “palpitations thyroid,” and this is a type more common in women. At our clinic, we can easily screen for these with a blood test.
4. Lifestyle, Medications, Menopause, and More
Too much caffeine, alcohol, smoking, lack of sleep, excessive dieting, hormonal changes during menopause, and certain medications (cold medicines, asthma medications, supplements, and the like) can also trigger palpitations. This is a category in which symptoms often improve with adjustments to your lifestyle.
Stress-Related or Heart-Related: Guideposts for Telling Them Apart
As suggested by how many people come in searching for the keyword “palpitations shortness of breath stress,” it tends to feel difficult to judge for yourself whether the cause is stress-related or heart-related. The characteristics listed below are only medical guideposts; the final diagnosis is made through examination and testing. Please use them as a reference when you are thinking about “which possibility seems more likely” for yourself.
Features Common to Stress- and Autonomic-Related Palpitations
- They tend to be influenced by the situation (in front of others, on transportation, at night, and so on)
- They often subside when you lie down and rest quietly
- Clear abnormalities tend not to show up on electrocardiograms or blood tests
- They may be accompanied by other autonomic symptoms such as dizziness, fatigue, headache, or gastrointestinal symptoms
- They may be accompanied by strong anxiety or anticipatory anxiety, such as the feeling that “I might die”
Features of Palpitations Where a Heart-Related Cause Should Be Considered
- They come on suddenly and strongly, unrelated to exercise or exertion
- They are accompanied by a cold sweat, nausea, chest pain, or dizziness
- They last for an hour or more, or you feel as though you are about to lose consciousness
- You already have cardiovascular risk factors such as hypertension, dyslipidemia, or diabetes
- A close relative died suddenly of heart disease before the age of 50
Concrete Guideposts for “When in Doubt, Call Emergency Services”
I do not want to stir up excessive anxiety, but in cases like the following, please consider calling emergency services (119) without hesitation.
- Chest pain accompanied by a cold sweat that lasts 15 minutes or more
- Your consciousness fades, or you actually faint
- Shallow, rapid breathing continues for several minutes or more, and your lips or fingertips turn purple (cyanosis)
If none of these apply, and the palpitations settle down after you lie down and rest a little, it is often perfectly fine to stay calm and consult a medical facility the next day or later.
Main Conditions That May Lie in the Background
Several conditions can be involved behind palpitations and shortness of breath. Here, I will introduce mainly the ones we frequently encounter in outpatient practice. For details, please also see the respective pages.
Panic Disorder
This is a type in which attacks of sudden, intense palpitations, shortness of breath, dizziness, and an intense fear that “I might die” last from several minutes to several tens of minutes and recur. Even when testing shows no abnormality in the heart, many people suffer from anticipatory anxiety—the worry that another attack might occur. Many people search for “Panic Disorder palpitations,” and recurring attacks and anticipatory anxiety are major features. For details, please also refer to the Panic Disorder page.
Autonomic Nervous System Disorder
This is a type in which the balance of the autonomic nervous system is disrupted, producing not only palpitations and shortness of breath but also a combination of dizziness, fatigue, sensitivity to cold, and gastrointestinal symptoms. Many of the people who search for “Autonomic Nervous System Disorder palpitations” also have other autonomic symptoms such as dizziness and fatigue. Chronic stress or a disrupted daily rhythm often lies in the background, and we aim for improvement through lifestyle adjustments and treatment as needed. Please also see the Autonomic Nervous System Disorder page.
Anxiety Disorder and Generalized Anxiety Disorder
Rather than clear attacks, this is a type in which vague anxiety or tension persists for a long time, leading to palpitations, shortness of breath, stiff shoulders, and insomnia. We have put together detailed information on the Anxiety Disorder page and the Generalized Anxiety Disorder page.
Hyperthyroidism (Graves’ Disease)
When thyroid hormones are secreted in excess, palpitations, sweating, weight loss, and trembling of the hands can occur even at rest. This can be screened for by measuring the thyroid hormones (TSH, FT3, FT4) with a blood test.
Iron-Deficiency Anemia
More common in women, this occurs when iron becomes deficient due to menstruation or an unbalanced diet, and the function of the red blood cells that carry oxygen declines, producing palpitations, shortness of breath on exertion, and fatigue. This too can be confirmed with a blood test.
Insomnia and Reduced Sleep Quality
Chronic lack of sleep can disrupt the autonomic nervous system and trigger palpitations and shortness of breath. Some people say, “After a night I couldn’t sleep, I started getting palpitations.” Please also see the Insomnia page.
When You Should See a Doctor: Three Guideposts
In my outpatient practice, I get the impression that a great many people hesitate, wondering, “Is it really okay to see a doctor for something like this?” I share the following three points as guideposts. If even one of them applies to you, it is a good time to consider seeing a doctor.
1. Symptoms Have Continued for More Than a Week
If it is something temporary, it may resolve on its own, but if palpitations and shortness of breath continue beyond a week, it is reassuring to take the time to sort out the cause once.
2. They Occur Three or More Times a Week
When the frequency increases, the impact on daily life grows larger, and you can easily fall into a vicious cycle in which the anxiety itself worsens the symptoms. I recommend forming an assessment early.
3. They Are Interfering with Work, Sleep, or Household Tasks
When symptoms are interfering with daily life—”I can’t concentrate at work,” “I wake up at night with palpitations,” “I have to stop in the middle of household tasks”—that is a perfectly valid reason to see a doctor. There is no need to hold back, thinking, “It’s only this much.”
You can make a reservation from First Visit. We accept reservations online or by phone.
The Flow of Tests We Can Perform at Our Clinic
Keldsen Family Clinic is a family clinic that combines Psychosomatic Medicine and Internal Medicine. A distinctive feature is that even with symptoms like palpitations and shortness of breath, where it is unclear “whether it’s the mind or the body,” we can evaluate everything together through a single point of contact. Even at the stage where you are unsure which hospital to visit, please feel free to consult us.
STEP1. Interview (5–10 minutes)
We carefully ask about when it started, in what situations it occurs, how long it lasts, and whether there are any other accompanying symptoms. We listen from both the mental and physical sides, asking about your daily rhythm, work, family situation, sleep, and more.
STEP2. Physical Findings and Electrocardiogram
We check your blood pressure, pulse, respiratory rate, oxygen saturation (SpO₂), and auscultation, and perform a 12-lead electrocardiogram as needed. Many people search for “palpitations electrocardiogram,” and we can perform it on the spot in the outpatient setting. For people who have frequent attacks, we may also consider a Holter electrocardiogram (24-hour electrocardiogram) at a later date.
STEP3. Blood Test
As needed, we check thyroid function (TSH, FT3, FT4), anemia (hemoglobin) and iron deficiency (ferritin), electrolytes, blood sugar, and liver and kidney function. This is an important step in distinguishing between palpitations from thyroid causes and palpitations from arrhythmia.
STEP4. Psychosomatic Evaluation
As needed, we use questionnaires that ask about depression, anxiety, and sleep (PHQ-9: degree of depression, GAD-7: degree of anxiety, AIS: sleep quality) to objectively organize the degree of mental burden. My impression is that the more someone feels “it might just be in my head,” the more reassured they tend to be when it is made visible.
STEP5. Discussing the Plan
Based on the results, we decide together with you whether “watchful waiting seems fine,” “we should start with lifestyle adjustments,” “we should add medication,” or “we should coordinate with a specialist in another field such as cardiology.” We never start medication out of the blue. We give top priority to your wishes and build a plan that does not feel forced.
STEP6. Coordination as Needed
If we determine from the tests at our clinic that a detailed cardiovascular examination is necessary, we will refer you to a nearby specialized medical facility. Conversely, we also welcome consultations about palpitations and shortness of breath that remain after another clinic has told you “your heart is fine.”
We also accept reservations from First Visit at the stage where you are uncertain about “palpitations shortness of breath stress.”
Self-Care You Can Do in Daily Life
What I feel in my daily outpatient practice is that when patients continue self-care on their own, a “sense of being able to control it themselves” returns, and many find that the anxiety itself becomes lighter. I introduce these as things to incorporate alongside, never in place of, medical care.
1. Regulate Your Breathing
The foundation of self-care is breathing. Try abdominal breathing in which you inhale through the nose over 4 seconds and slowly exhale through the mouth over 6–8 seconds, with one set of 5–10 breaths, several times a day. It is a widely known breathing technique, but exhaling for a long time makes it easier for the parasympathetic nervous system to take over.
2. Reconsider Caffeine, Alcohol, and Nicotine
Coffee, energy drinks, strong tea, alcohol, and tobacco are representative factors that easily trigger palpitations. Even without quitting completely, just adjusting little by little—holding off from the evening onward, or reducing the number of drinks per day—can sometimes make a difference.
3. Regulate Your Sleep
Try to keep your bedtime and wake-up time as consistent as possible, and reduce smartphone and PC work before bed. When shallow sleep continues, the autonomic nervous system becomes disrupted, making palpitations and shortness of breath more likely to occur.
4. Incorporate Light Exercise
Light aerobic exercise such as walking about three times a week for 20–30 minutes per session, or stretching and yoga, is well suited. It does not need to be intense exercise; the key is to continue at an intensity where you “break a slight sweat.”
5. Keep a “Palpitation Diary” for Self-Monitoring
If you make a simple note of the time it occurred, the situation, how long it lasted, and what happened before and after, patterns become easier to see in the outpatient setting as well. If you can also notice signs other than palpitations early—such as “my sleep has been a little shallow lately” or “my stomach has been off”—it becomes easier to respond before the symptoms grow larger. A notes app on your smartphone is perfectly fine.
Measures to Prevent Palpitations and Shortness of Breath
1. Be Mindful of a Rhythm of Rest
Periodically look back and ask yourself, “It’s fine to have busy periods, but has the busy state become the norm?” Setting aside days to consciously rest, on a weekly and monthly basis, makes the autonomic nervous system less likely to become disrupted.
2. Build a System to Avoid Bottling Up Stress
Maintain relationships in which you can talk frequently with people you trust—family, friends, or colleagues at work. Having time to “switch your mood,” such as hobbies or exercise outside of work, also contributes to long-term prevention.
3. Regular Checkups and Blood Tests
Having a checkup once a year that includes blood pressure, an electrocardiogram, a blood test, and thyroid function helps reduce the chance of overlooking causes seen in internal medicine.
Frequently Asked Questions
Q1. Are consultations for palpitations and shortness of breath covered by insurance?
Yes, in most cases they are covered by insurance. Electrocardiograms, blood tests, and psychosomatic evaluations can all be performed within the scope of insured care. For details, please also refer to the reception desk or First Visit.
Q2. Do I need a reservation?
In principle, we operate on a reservation-priority basis. You can make a reservation online or by phone. We may be able to accommodate same-day visits if there is an opening, so when you are in difficulty, please contact us first.
Q3. Can you accommodate telemedicine?
For people whose symptoms are stable, or who are too busy to come in, Telemedicine is also available. However, for a first visit, or at times when an electrocardiogram or blood test is needed, we may recommend an in-person visit.
Q4. I feel hesitant about taking medication.
Rather than “starting with medication right away,” there are also options for starting with lifestyle adjustments, breathing techniques, organizing your thoughts, and counseling-style dialogue. We will build a treatment plan you can accept together, so please feel free to share your wishes with us.
Q5. May I come in together with my family?
Of course, we welcome it. Visiting together with your family is very welcome. Situations that are hard to explain on your own can often become clearer through what your family shares. This is also a strength unique to our clinic, which is committed to family care.
Q6. How long will it take to feel better?
It cannot be stated in general terms because it varies depending on the cause, course, and life circumstances. However, for stress- and autonomic-related cases, my impression is that many people gradually feel better by combining lifestyle adjustments with treatment as needed. Rather than aiming to be “completely back to normal in a short time,” I hope we can work together with an image of getting better little by little.
Q7. How do I get to the clinic?
Keldsen Family Clinic is located in Oizumi-Gakuen, Nerima-ku, Tokyo. Take the Seibu Bus and get off at “Oizumi Post Office” (Oizumi Yubinkyoku), a 1-minute walk away. For guidance if you are coming by car, please contact the reception desk.
In Closing: Come In So We Can Help You Judge, and Be Seen as a Family
Palpitations and shortness of breath are symptoms in which multiple causes—heart-related, stress-related, and conditions seen in internal medicine—can overlap. You do not need to figure out the cause yourself before seeing a doctor.
You are welcome to come in just as you are, in a state of “I don’t know whether this is my heart or stress.”
Come in so that we can help you judge—that is exactly what a clinic like ours, combining Psychosomatic Medicine and Internal Medicine, is here for. With a system that can address any of palpitations, shortness of breath, and stress, we are waiting for you in our outpatient clinic.
Also, at Keldsen Family Clinic, we very much welcome visits not only by the individual but together with family. The more a symptom tends to be carried alone, the more I feel that proceeding with an assessment while sharing it with family often leads to things settling down sooner.
We aim to be a local primary care clinic that can stand beside you not as an “individual,” but as a “family unit.”
“My palpitations keep going and I’m anxious.” “My shortness of breath won’t go away.” “I don’t know which department to go to.” It is precisely at such a moment of uncertainty that we hope you will feel free to consult us.
For access, take the Seibu Bus from Oizumi-Gakuen and get off at “Oizumi Post Office,” a 1-minute walk away. We also accommodate weekend and holiday consultations as well as telemedicine, so please use our services in a way that fits your lifestyle.