Restlessness with palpitations can occur with anxiety or panic, but can also result from an abnormal heart rhythm, dehydration, anemia, thyroid disease, low blood sugar, stimulant use, or medication side effects. Potential triggers include caffeine, alcohol, nicotine, recreational drugs, poor sleep, and some inhalers or thyroid medicines. NHS guidance recommends assessment when episodes recur, worsen, or persist.

Seek emergency care now if palpitations are ongoing or occur with:

Do not drive yourself. Call local emergency services.

Arrange a medical review soon if this is new, recurrent, lasts more than a few minutes, is worsening, or you have heart disease or a family history of sudden cardiac problems. Treatment depends on the cause, so avoid starting medicines such as propranolol or sedatives without medical advice.

If the “restlessness” began after starting or increasing an antipsychotic, antidepressant, anti-nausea drug such as metoclopramide, or similar medication, it may be akathisia. Contact the prescriber promptly rather than stopping medication suddenly.