What is a fluttering heart?

A fluttering heart or heart flutter is commonly used to describe certain chest symptoms or cardiovascular conditions. It is not a specific medical term but in most instances it describes palpitations – the perception of the heart beating harder or faster. The term fluttering heart referring to palpitations must also be differentiated from a medical condition known as atrial flutter which is a type of abnormal rhythm of the heart. Palpitations are the most common symptom in an atrial flutter but many cases are also asymptomatic, meaning that a person will not experience any symptoms of an atrial flutter. Although it can be confusing, a fluttering heart can be used to refer to a symptom like palpitations, or a condition like an atrial flutter.

Meaning of a fluttering heart

A fluttering heart can have several meanings. The two most common are palpitations and atrial flutter. However, it is sometimes a less commonly used term to refer to a mitral valve prolapse. Occasionally even chest discomfort associated with anxiety or stress (similar to ‘butterflies in the stomach’), heartburn or even angina can be described as a fluttering heart but this is rare. The confusion arises with either the types of sensations (symptoms) described by a patient as a ‘fluttering heart’ or complex medical conditions which are simply explained as a type of heart fluttering by a medical professional to the lay person.

It is important to understand the meaning of the two most common types of heart fluttering – the heart symptom and the heart condition.

  • Palpitations are an awareness of the heart beating. This is most often a result of the heart beating harder or faster than normal but can occur even with normal heart rhythm, rate and contractility.
  • Atrial flutter is an irregular heart rhythm where the atria of the heart beat more rapidly than normal thereby partially disrupting the flow of blood through the heart. It is known as an arrhythmia and arises due to an abnormality in the electrical system of the heart. A more common type of arrhythmia that is very similar to an atrial flutter is a condition known as atrial fibrillation.

Causes of a fluttering heart

The heart is constantly beating throughout life but a person is usually unable to perceive the constant relaxation and contraction. It is a muscular pump that circulates blood throughout the body.  Blood enters the heart through the atria (singular ~ atrium), passes into the ventricles and is pushed out of the heart through the ventricles. This passage of blood needs to be carefully coordinated by :

The electrical impulses start in the sinoatrial (SA) node which is the natural pacemaker. It then spreads to the AV node where it is delayed for a short while before spreading to the AV bundle. This ensures that the atria contract first thereby filling the ventricles with blood and then the ventricles contract pushing the blood out of the heart.

The heart valves between the atrium and ventricles (tricuspid and mitral valves) close when the ventricles contract. This ensures that blood flows out of the ventricles into the great vessels (pulmonary artery and aorta) and not backwards into the atria.

When these processes are disrupted leading to stronger, faster or irregular rhythm, a person may be able to perceive the beating heart. It is described as a pounding feeling in the chest or a sensation that the heart is racing or skipped a beat.

 The heart may beat faster or harder under certain physiological conditions such as :

  • Strong emotion – shock, fear, anxiety.
  • Psychological stress.
  • Strenuous physical activity.

In most of these cases the heart rate increases but the rhythm is still normal.

Medication and substances

Other factors associated with substance use (iatrogenic) may be responsible for both an abnormality of heart rate and rhythm.

  • Excessive alcohol consumption.
  • Excessive stimulant use like caffeine or nicotine.
  • Illicit drugs (narcotics)
  • Certain medication like diet pills and cold medication containing pseudoephedrine as well as drugs to increase thyroid activity.

Diseases and disorders

Palpitations may also occur with certain medical conditions such as :

  • Hormonal fluctuations during pregnancy or menopause.
  • High fever.
  • Arrhythmias like atrial flutter, atrial fibrillation, ventricular and supraventricular tachycardia.
  • Tachycardia – rapid heart rate.
  • Bradycardia – low heart rate.
  • Iron deficiency anemia.

Symptoms of a Fluttering Heart

Palpitations are a symptom commonly described as a fluttering heart. It may also be accompanied by other symptoms such as :

  • Shortness of breath
  • Chest pain
  • Dizziness
  • Fainting episodes
  • Anxiety
  • Weakness

These symptoms are also seen in arrhythmias such as atrial flutter and atrial fibrillation.

Fluttering Heart in Women

Although a fluttering heart affects both males and females, when it happens in women due to hormonal changes there are also additional symptoms. Pregnant women are usually aware of their state but women undergoing peri-menopause and menopause are often not aware of the change at first. Therefore other symptoms of menopause need to be noted such as :

  • Hot flashes
  • Mood swings
  • Irregular periods
  • Vaginal dryness

Treatment of Fluttering Heart

There is no specific treatment for palpitations since it is a symptom of an underlying disorder. Instead the cause should be identified and treated in order to ease the sensation. In conditions such as atrial flutter, the following treatment options may be considered :

  • Restoring the rhythm of the heart by defibrillation – cardioversion.
  • Controlling the heart rate and rhythm with medication or surgical procedures (AV node ablation) and a pacemaker.
  • Reducing the risk of complications like blood clots associated with irregular heart beat by the use of medication.

An arrhythmia needs to be diagnosed and monitored before it is treated. Majority of arrhythmias remain unnoticed for long periods in life. Other conditions like thyroid disorders and female hormone fluctuations also need to be treated accordingly. However, when there are no specific condition that can be isolated as a possible cause of a fluttering heart, then certain conservative measures should be implemented. This includes :

  • Stress management.
  • Treating underlying anxiety.
  • Avoiding stimulants like nicotine and caffeine.
  • Drinking alcohol in moderation.
  • Taking iron supplements for anemia.
  • Discontinue over-the-counter dieting pills and cold and flu medication.

Article reviewed by Dr. Greg. Last updated on January 4, 2012