Can the physical symptoms of anxiety manifest first before the mental symptoms? ie-- racing heartbeat followed by sense of panic/fear of impending death? or do the mental symptoms always come first?

Anxiety: It can be variable. Some people have physiological sx's from anxiety but don't recognize their mood is anxious. For some people, feeling anxious has become so normal to them, that they are unaware that it is occurring or that it is not normal. Most however, are aware when they are experiencing panic attacks. If you don't think you are anxious But have physical sx's get eval to R/O medical causes