“At a cardiac arrest, the first procedure is to take your own pulse first.”
—The House of God by Samuel Shem
That famous line told to med students is both obvious and true. It’s a reminder that in moments of chaos, we have to pause long enough to check in with ourselves. As a cardiac electrophysiologist, I’ve come to see that the need for internal awareness doesn’t just apply during a code blue. It applies in our day-to-day lives where we are increasingly challenged with uncertainty, information overload, and pervasive unease. Sometimes our bodies can betray us with symptoms that don’t always reflect reality but can trigger catastrophic thinking.
When the Heart Races, the Mind Often Follows
A racing heartbeat, or “palpitations,” is a common symptom seen in the office or ER. It might reflect fear, excitement, or overexertion, but it could also be due to a short circuit in the heart’s electrical system called an arrhythmia. The challenge is that the symptoms of panic and arrhythmia often look the same on the surface: rapid heartbeat, shortness of breath, dizziness, even chest discomfort. And in our fast-paced culture, these experiences are often misdiagnosed or minimized based on appearances. The key is learning to interpret them accurately and compassionately.
A Tale of Two Patients
I remember a healthy 20 year-old woman who presented after several ER visits for “panic attacks.” Her symptoms followed a pattern: sudden, pounding heartbeat and a feeling of dread. By the time she arrived at the ER, her heart rate had normalized so she was diagnosed with anxiety. During one episode, she used her Apple Watch to record an ECG (electrocardiogram). She showed it to me and the diagnosis was clear: supraventricular tachycardia, or SVT, a type of arrhythmia often affecting young and healthy people. Her episodes occurred at rest, not during stress. That detail fits with how SVT behaves in that it often occurs when the heartbeat is slower, which allows premature beats to kick off an episode. Just as it suddenly starts, it suddenly stops. Many patients describe it as a light switch effect. We treated it with a catheter ablation procedure which cauterizes the short-circuit. Her symptoms resolved with no more “panic attacks.”
Contrast her story with that of a 50-year-old executive I treated who was juggling deadlines, consuming large amounts of caffeine, and self-medicating his stress with alcohol. His heart would race during tense meetings, arguments, or when lying awake at 2 a.m. thinking about everything that still needed to be done. He was worried he had a serious heart condition, especially since his father died of a cardiac arrest. But when we monitored his heart, what we found was sinus tachycardia: a normal rhythm, just accelerated by his sympathetic nervous system and the stress response fueled by adrenaline. We sometimes use a drug called isoproterenol in the electrophysiology lab to simulate adrenaline and provoke arrhythmias. In his case, life itself had become his isoproterenol.
What Stress Really Does to the Brain
These two patients had different diagnoses but the same fear: something was wrong with their heart. One had an arrhythmia mistaken for anxiety, and the other had a stress-induced elevation in heart rate mistaken for an arrhythmia. Both cases demonstrate that the heart and mind have bidirectional communication, which can confuse patients and providers. Under stress, cortisol and adrenaline surge, and the brain’s prefrontal cortex, which is responsible for decision-making, shuts down. Attention narrows, memory fragments, and perception is distorted. Neuroscientists have shown how stress hijacks the brain’s decision-making pathways leading to reactive thinking. A racing heart can feel like impending doom, even when there is no true danger. Chronic mental stress, especially worry and rumination, has also been shown to keep the body physiologically activated long after the stressor has passed. This is called “perseverative cognition” and it can elevate blood pressure and reduce heart rate variability. Prolonged exposure to stress can result in an elevated cortisol state, which can feed back into the nervous system and further blur the line between emotional and physical symptoms. Add to that the phenomenon of diagnostic overshadowing, where emotional distress is mistaken for physical illness or vice versa, and the risk of mislabeling becomes even greater.
Wearable devices like smartwatches and portable ECGs can be helpful in giving real-time data, but they’re a double-edged sword. Without context, a spike in heart rate can increase fear. Data alone can’t replace the nuance of a good history, nor can it distinguish between a normal heart rhythm sped up by adrenaline and a true cardiac arrhythmia.
Restoring Rhythm Through the Nervous System
I encourage my patients to lean into practices that regulate the body’s natural rhythm. Meditation, breathwork, and yoga directly stimulate the parasympathetic nervous system through the vagus nerve, helping bring heart rate, breath, and thought into better alignment. In SVT, we use vagal maneuvers, like bearing down or splashing cold water on the face, to restore rhythm. Even these physical techniques reflect the fact that when the nervous system feels safe, the heart often follows.
Take Your Pulse
That’s why I keep returning to this phrase: Take your own pulse first. Pausing to take your pulse reminds us to tune in before we react. It helps prompt us to ask: am I truly in danger or am I reacting to past trauma triggered by current events or inner narratives? These questions, if asked early enough, can help us avoid reactions that can lead to personal suffering, relationship tension, or being mislabeled, misdiagnosed, or unseen. Whether it’s a dismissed arrhythmia or stress misread as cardiac disease, the lesson is the same. The heart is often the first to react. And while the ECG can tell us part of the story, it’s rarely the whole thing. But all of it needs to be interpreted within the context of the situation and the history.
