The phrase highlights a very high level of fear or nervousness, not just a slight worry. Watching the horror movie alone at night, her heart was in her mouth.
Pro Tip 2/3
Figurative Speech
Understand it's a metaphor; someone's heart isn't literally in their mouth, it's used to express strong emotions. When the lights went out, his heart was in his mouth.
Pro Tip 3/3
Temporary State
Use it when describing a momentary feeling, usually related to a specific event or situation. Her heart was in her mouth as she awaited the competition results.