What Causes Heart Flutters?

By Stephen T. Sinatra, M.D., F.A.C.C., F.A.C.N., C.N.S., C.B.T.

Pick up any romance novel, and the fluttering heart is sure to be mentioned at least once. Usually it’s the heart of the heroine, full of love and joy. (Or so I’m told by avid readers of the genre.)

In real life, though, a fluttering heart is a far less romantic character. It can be annoying, worrisome, or even risky, depending on its specific cause.

People describe the sensation of heart fluttering in many ways. Sometimes they’ll say straight out, “It feels like a flutter.” Other times, they’ll describe their heart as “skipping a beat,” “flipping over in my chest,” or “a pause.” Sometimes the sensations are accompanied by lightheadedness and a strange feeling in the chest.

Clinically, these patients are usually describing premature atrial contractions (PACs), premature ventricular contractions (PVCs), or atrial fibrillation. PACs and PVCs occur when the heart’s atria or ventricles contract out of sequence. In both, the affected chamber beats slightly ahead of when it’s supposed to. This is followed by a longer than normal pause, while the heart rhythm resets itself.

This video of an EKG shows the offbeat signal, followed by a noticeably longer pause between beats.

A-fib occurs when the atria quiver in no particular rhythm instead of regularly contracting. It is “irregularly irregular.”

Causes of Heart Flutters

As is true with all heart palpitations, PACs and PVCs are often caused by stress or other troubling emotions, as well as certain foods—alcohol, sugar, and caffeine, especially. However, this particular type of irregularity may also be brought on by more serious concerns, such as—

  • Coronary artery disease, heart failure, and heart attacks
  • Lack of oxygen to the heart
  • Mitral valve prolapse
  • High blood pressure
  • Diabetes
  • Thyroid or other metabolic imbalance (particularly electrolytes)
  • Medications such as diuretics, calcium channel blockers, anti-depressants, and anti-arrhythmics

These conditions can also cause a-fib, though a-fib is also often linked to an improper functioning of the heart’s natural pacemaker.

Exactly How Dangerous Are Heart Flutters?

The answer to this question depends on your specific situation. But in general, most people fall into one of three groups:

Minimal risk.

If your heart flutters are caused by occasional PACs and/or PVCs, and your heart is healthy and has no structural abnormalities, the fluttering is not dangerous. We call these “benign PACs or PVCs”—and, in fact, virtually everyone experiences this type of palpitation at some time in their life, including me. I usually recommend that folks in this category focus on lifestyle changes, like learning how to reduce stress levels and avoiding foods that are known to cause heart palpitations, that can help lessen the frequency of PACs and PVCs.

Some risk.

At least one study has linked a high frequency of PVCs (more than 30 per hour) with greater risk of heart disease and sudden cardiac death, so your risk increases somewhat if you have a lot of them. Patients in this category may be prescribed a low-dose beta blocker to help minimize the fluttering sensation and to calm the heart. It’s also a good idea to continue with follow-up visits so your doctor can monitor your heart to make sure a more significant problem doesn’t develop.

Moderate to high risk.

If the cause of your heart flutters is a-fib, or your heart has a structural abnormality or is damaged from a prior heart attack, then the fluttering is more of a concern. In this case, the underlying cause of the condition requires treatment, in order to prevent the PVCs from triggering more complex—and potentially deadly—arrhythmias. Also, if the cause of your heart flutters is a-fib, you are at a much higher risk of heart attack and stroke. Because the atria don’t contract normally in a-fib, blood is more likely to pool there and clots can form. This is why most patients with a-fib are prescribed a blood thinner like warfarin or one of the new-age blood thinners often advertised on television (Pradaxa, Eliquis, and Xarelto).

When to Worry About Heart Palpitations

Always Get a Fluttering Heart Checked Out

If you’re experiencing recurring flutters in your chest, I recommend seeing an internist or cardiologist to get them checked out—especially if the episodes occur under exertion. Effectively treating and managing your risk depends on identifying the cause of the fluttering.


© Stephen Sinatra, MD. All rights reserved.

Leave a Reply


  1. Erine M Koulianos

    on April 26, 2017 at 2:26 pm

    I have been diagnosed with SVT. Since 2003. My lifestyle changes have helped but I live in fear that it would kick in on plane so I do not travel.
    Is there anyway to get consultation with Dr. Sinatra.
    Thank you for your consideration.
    ERine Koulianos

  2. Sorida

    on April 12, 2018 at 5:47 pm

    Bonjour my name is Sorida I’m 70 years old I was an exempler athletic teacher after 20 years of teaching I had surgeries on my left femur with 2screws and poor mobility in the left leg…now my heart cause such palpitation and fatigue may by fluttering my Dr want me to do scan but l don’t like l had many radioactive but not something to help the symptom l take multivitamin. Magnesium hawthorne gutagola the please contact me.

  3. Dan W.

    on April 13, 2018 at 12:08 am

    This is really good info. I am 70, and about 5 years ago, I was having almost nightly a fluttering of my heart during the night time while I was trying to sleep (mostly when I was on my left side). Based on some info, I started taking a quality CQ-10, which resulted in about 99% of the issue going away quickly. I was taking a multi-vitamin mineral at that time and still take these type of supplements. About 3 years ago, I was having nighttime lower leg cramps during the nighttime. Based on some info I received, I started taking a anti-cramp magnesium supplement, the cramps were eliminated like 99% also. But the Mag…. is helping my heart health also. I did have some tests performed by a Cardiologist, and found that I need to do more basic exercise which I am doing with good results I feel…

  4. Ray laskowski

    on April 14, 2018 at 4:45 am

    Not sure if it’s my heart ❤️ fluttering or a muscle issue. I have been done weight lifting, and various stretches. No loss of breath , palpitations.

  5. Ira E.

    on April 3, 2019 at 12:36 pm

    You missed something. I had atrial flutter, and it was called an emergency. A very fast, steady heartbeat may not be felt, but in a month it can wear out the heart and the patient does of heart failure.
    Your article was about flutters that are felt. The one that is not felt can be fatal.

  6. Patricia P

    on April 4, 2019 at 1:30 am

    This summerI started having atrial fibrillation. I have severe hypertrophy. I found that I could arrest the atrial fibrillation attacks with the following smoothie: yogurt and blueberries or raspberries, spinach or beet greens, water, a piece of a banana, lecithin, protein powder which I varied the type of, (hemp seed powder, grass fed whey powder, egg protein powder) 1/4 of a whole organic lemon and ice cubes. Then I would put into it about 2 g of powdered taurine, a teaspoon full of ascorbic acid or calcium ascorbate form of vitamin c, 2 g of magnesium citrate, 2 g of l-arginine, 2 g of d-ribose. I put in other powdered supplements,but those are the essential ones for the heart. Then I drank that smoothie while sitting with my feet in a basin of warm water to which I added about a shot glass full of strong hydrogen peroxide (127 volume) and a handful of magnesium sulphate. Often the atrial fibrillation would stop after I drank the smoothie and was sitting with my feet in the basin of water. I added to my supplement program Jarrow’s Max DHA fish oil, and took the dose up to 5 capsules (standard dose is two capsules) but I had to lower that dose to 2 capsules of the Jarrow Max DHA because my cardiologist started me on an anti-coagulant. I already took 300 mg of Jarrow’s QH Absorb form of Co Q10 every 2 hours, 7 times a day for the hypertrophy. My doctor, Dr.Majid Ali in NYC had saved me from having to have open heart surgery with the Co Q 10 trick. Previously my heart had a double obstruction even at rest and I was taking 300 mg of Jarrow’s Qh Absorb ubiquinol three times a day. Raising the dose of Co Q10 to seven times a day for just one day prior to the test, allowed my heart to have enough oxygen that it stopped obstructing other than slightly obstructing under the heaviest stress of a stress echo cardiogram. I was also able to perform quite well on the echo stress test thanks to the high and frequent dose of Qh Absorb Co Q 10. The surgeon Dr.Paolo Ferazzi ( a famous Italian heart surgeon) who has performed more cardiac myectomies than any surgeon in Europe, who had previously said he thought my heart was too damaged to operate on (not enough diastolic function) then wanted to operate. But the doctor (not a technician) who performed the echo stress test told me that while at first seeing a heart so hypertrophied upset her,then she began to notice that my heart was functioning rather well and had only the slightest obstruction under the heaviest stress. She advised me not to do the surgery, which the surgeon then changed his mind and wanted to do. She told me to keep working with the NYC doctor. Eventually I found an excellent cardiologist, Dr. Iacoppo Olivotto in Florence at Careggi University who told me that I was on the wrong beta blocker, that they have been using Nadololo for hypertrophy for over 20 years. He also gave me Ritmodan. Between taking the two pharmaceuticals and using at first heavy doses of magnesium sulphate in bath, plus about 100 ml of the 127 volume hydrogen peroxide in the bath, with half a box of sodium bicarbonate in the last 20 minutes of the bath, and 3 of Jarrow’s Max DHA (high DHA omega 3 fish oil) per day, I was able to control the previously uncontrollable arrythmias from the severe hypertrophy. It took both the magnesium and the High DHA fish oil and the drugs to control the arrhythmia. But ti also took the Nadololo 80 mg (half in the morning and half at night) and Ritmodan 250 mg (half in the mooring and half at night) that Dr. Olivotto gave me. Recently he told me that in the past he had seen patients with severe hypertrophy like mine “go down rather fast” but that he is amazed at how well my heart is holding. It has been almost 5 years that I have been on the high dose Co Q10 since the day of that stress test which demonstrated to me how effective Dr. Ali’s prescription for high dose Co Q10 really was.
    My thought on my atrial fibrillation was that it was an oxygen problem.So that is how I designed the smoothie and the foot bath treatment. I also took oxygen afterward for a few hours or even all night at 2 1/2 liters per minute. I ate three large pieces of candied ginger a day until I went on the anti-coagulant. On the anti-coagulant I lowered the dose of DHA from 5 capsules a day to 2, out of fear of a cross reaction. I also took out the 120 mg of gingko and high potency Curcurmin (Jarrow’s Curcurmin 95) which I had been taking. I lowered my dose of vitamin E from 400 mg (Jarrow’s Famil-E which has all natural forms of vitamin E) to dividing the capsule over three days.
    On the anti coagulants one has to also think of the impact of certain foods, high doses of cinnamon, ginger, and chili peppers or garlic are also strong blood. thinners.
    In my case the atrial fibrillation appears to come from an irritation of the vagus nerve which Dr. Olivotto has confirmed. I have not yet figured out how to get rid of that problem with the vagus nerve. I think stress is part of it.
    I also read Dr. Stephen Gundry’s,”The Plant Paradox”,which is very interesting, and I highly recommend along with Dr. Sinatra’s books.
    I too,would like to consult with Dr. Sinatra, as it was finding a book by him which made me first raise the dose of Co Q10 to 400 mg/day, and convinced me to take D ribose.and l-carnithine. Dr. Ali also had me on injectable taurine, glutahione and B-12,but I stopped taking those injections after I had a stroke. Fortunately I got to the hospital in time to have the colt busting drug, and since I had the very high doses of Co Q10 in my system, I suffered almost no damage from the stroke. (Only an almost invisible damage to the nerve on the left side of my face which controls the area over my lip—imperceptible to most people.) The stroke happened when I overdosed on ginger tea while trying to change over from the three large pieces of ginger a day to ginger tea. I caused an old ovarian cyst to bleed, so I backed off and didn’t take anything that day to thin my blood, and had the stroke after a brief fibrillation at about 9 o’clock that night.

  7. Eileen

    on April 4, 2019 at 12:31 pm

    Four years ago I had up to 20 PVCs per minute, not 30 per hour. Could barely walk 75 steps without having to stop as I felt I would pass out. Had seen a specialist 2 years prior when this problem was at 10 per minute who told me it was JUST PVCs, they aren’t dangerous. Felt the profuse sweating, shortness of breath, and extreme fatigue that most associate with a heart attack, but mine was PVCs. Had the huge thumps that happened when my heart had to pump the huge amounts of blood that gathered between beats. Not sure if I am the absolute Queen of PVC sufferers, but probably was.
    Had an ablation and now any PVCs go unnoticed and from the ECGs it looks like they are few and far between. Change of doctors who took my condition seriously and I got treatment instead of a pat on the head and reassurance that all was fine.

  8. Carol

    on April 4, 2019 at 2:37 pm

    This article on the newer blood thinners was helpful. I was put on eloquis 2 days ago and a beta blocker toprol XL. I’ve had atrial fibrillation for 10 years that has become more frequent the past 2 weeks. I have a mild mitral valve prolapse and leaky valves, but was told it wasn’t the reason for my atrial fibrillation. I have a echo cardiogram scheduled for next week. I guess if the frequency doesn’t stop, I might have the ablation done.

  9. patty

    on April 4, 2019 at 8:10 pm

    I had a car accident, and had to take prednesone for back problems from the accident, and also was doing water therapy for pain, and my heart raced to a pulse rate of 128, and stayed that rate for several hours, until I went to E.R., and was given a beta blocker, and then it stabilized. I was told it was atrial flutter for several hrs. They then gave me blood thinner now for life, and I have had no issues with afib, or flutter, but why keep me on blood thinner after all my test came back good?? I hae been taking this blood thinner now ever since the one bout with the atrial flutter while doing water therapy, and was on prednesone also. could the prednesone have caused the flutter??
    Thank you, Patty

  10. Linda H.

    on April 5, 2019 at 12:13 am

    I have Wolff-Parkinson-White syndrome. How dangerous is this type of heart condition?

  11. Linda Thomas

    on October 19, 2020 at 12:29 pm

    Hi Dr. Sinatra,
    There is a puzzle that my doctors can’t solve. I’ve never had a heart flutter and I’m 81 years old. My last stress test was normal in all chambers, and I reached the rate set for me on the treadmill recently, with pictures before and after. I do have however, for the past two years, unrelenting and chronic hot flashes which seems to promote high blood pressure especially at night. I take two of your Omega Q Plus Max , Vitamin D3, K2, magnesium citrate and two grams of the amino acid L-aginine within 24 hours every day, because I believe it helps me maintain heathy arteries and my doctor approves. When my BP goes high, my heart rate stays nicely in the area of 63-70. My only prescription is a beta blocker, Carvedilol, 12.5, am and pm. Deep slow breathing also succeeds amazingly to bring my pressure back to normal for that episode, but not for good. Any thoughts of the cause of these distressing episodes? Or where I might turn for help?

  12. shafqat mir

    on October 19, 2020 at 2:16 pm

    having SVT for a long time i keep metoprolol 50mg in my pocket all the time and i swallow one if beats come along, yes relief

    after 2 hours or three, i am 75 cannot go for ablation if i have SVT also tried diltiazem 240 mg regularly to keep pressure down

    the these 2 drugs have helped me a lot
    i am pharmacist

  13. shafqat mir

    on October 19, 2020 at 2:18 pm

    any folks can try this formula it might be helpfull for SVT ONLY

  14. Sandi bergeron

    on November 5, 2020 at 3:50 pm

    Hi Linda,
    Thank you for reaching out. This is what Dr. Sinatra had to say:
    Try walking barefoot on Mother Earth. You can also read our book “Earthing, the Greatest Health Discovery Ever”.
    Here is the trailer to an informative movie on the topic:
    I hope this helps,
    Sandi B.
    Heart MD Institute Administrator

  15. Anthony Veerderese

    on March 24, 2021 at 10:06 am

    I live in beachwood,nj. Could you recommend a metabolic cardiologist to me?

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