Heart flutters, technically known as palpitations, are a common symptom involving a heightened awareness of one’s own heartbeat. This sensation can feel startling or uncomfortable, often causing worry about heart health. While frequent and often temporary, palpitations represent a sudden change in the heart’s rhythm that normally goes unnoticed. This article explains how flutters are perceived, explores their most frequent causes, and provides guidance on when to seek medical consultation.
Describing the Sensation
Individuals report a variety of sensory experiences, often drawing attention to the chest, throat, or neck area. A common description is the feeling of a “skipped beat,” where the heart pauses briefly before resuming with a forceful “thump” or “pounding.” This sensation often results from a premature contraction of the heart’s upper or lower chambers.
Alternatively, the sensation may be described as a rapid “fluttering” or “quivering,” sometimes compared to a fish flopping in the chest. The heart may also feel like it is suddenly “racing” or “pounding out of the chest,” accompanying an abnormally fast heart rate known as tachycardia. These palpitations can occur at any time, whether during physical activity, sitting quietly, or lying down to sleep.
Common Triggers and Underlying Conditions
Heart flutters arise from a wide range of factors, separated into temporary lifestyle triggers and persistent underlying medical conditions. Palpitations often result from stimulating substances, such as high doses of caffeine or nicotine. Emotional states like intense stress, anxiety, or panic attacks trigger the release of adrenaline, which accelerates the heart rate as part of the body’s “fight or flight” response.
Lifestyle factors such as strenuous exercise, dehydration, lack of sleep, or alcohol consumption can also induce palpitations. Additionally, certain over-the-counter and prescription medications, including cold remedies, asthma inhalers, and thyroid medications, may have a stimulatory effect on the heart muscle. These causes are typically benign and do not indicate a problem with the heart’s structure.
Heart flutters may also be symptomatic of underlying medical issues requiring professional attention. Arrhythmias, disturbances in the heart’s electrical rhythm, are a common cause, including premature ventricular contractions (PVCs) or premature atrial contractions (PACs), which create the feeling of a skipped beat. Other rhythm disorders, like atrial fibrillation or atrial flutter, involve rapid or chaotic electrical signaling in the heart’s upper chambers.
Conditions outside of the heart can also affect its rhythm. An overactive thyroid gland (hyperthyroidism) floods the body with hormones that increase metabolic rate and heart speed. Anemia (a deficiency of oxygen-carrying red blood cells) or imbalances in electrolytes like potassium and magnesium can disrupt the heart’s electrical stability. Structural heart issues, such as heart valve problems or cardiomyopathy, may also manifest as palpitations.
Recognizing Warning Signs
Certain accompanying symptoms suggest a more urgent medical evaluation is necessary. The presence of chest pain, pressure, or tightness alongside the palpitations should be immediately addressed, as these may signal a serious cardiac event. Any episode of heart flutters that occurs with severe shortness of breath indicates that the heart may not be effectively pumping blood throughout the body.
Other warning signs include feeling faint, dizzy, or experiencing a full loss of consciousness (syncope). These symptoms suggest a significant drop in blood pressure or a dangerous, sustained irregular heart rhythm affecting blood flow to the brain. Flutters that happen during intense physical exertion, such as during a run or workout, may also be a red flag, particularly if they are new or worsening.
Management and Next Steps
For flutters attributed to temporary triggers, self-management involves simple modifications to daily habits. Reducing or eliminating stimulants like caffeine, nicotine, and alcohol can significantly decrease the frequency of palpitations. Incorporating stress reduction techniques, such as deep breathing exercises or meditation, helps mitigate the adrenaline-driven heart rate increases associated with anxiety.
Ensuring adequate hydration and maintaining a balanced diet helps prevent electrolyte imbalances that can destabilize the heart’s rhythm. If palpitations are frequent, persistent, or associated with any warning signs, a medical evaluation is the appropriate next step. A physician typically begins with a detailed patient history and a physical examination, including an electrocardiogram (EKG or ECG) to record the heart’s electrical activity at rest.
To capture infrequent flutters, a doctor may recommend wearing a portable monitor, such as a Holter monitor (24 to 48 hours) or an event recorder (up to a month). Blood tests are often ordered to check for non-cardiac causes, including thyroid hormone levels, a complete blood count for anemia, and electrolyte balance. These diagnostic steps help identify an underlying condition that requires specific treatment, such as medication or a procedural intervention.