Chest pain and palpitations are commonly described in the general population and are frequent presenting symptoms in all medical settings. Although often transient, they can be persistent and are associated with considerable disability, distress, and concern about heart disease and use of medical resources. Both symptoms are associated with panic but also with other psychiatric disorders. It is most useful to consider etiology as multicausal and interactive; psychological factors affect interpretation of bodily perceptions and have deleterious effects on quality of life and use of medical resources. There is evidence that general measures and specific drug and psychological treatments can be effective. There is still uncertainty about the most appropriate ways of providing effective care to large numbers of patients.