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.

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