Fluttering of the heart - causes, therapy and symptoms

Fluttering of the heart - causes, therapy and symptoms

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The term "fluttering heart" describes very different phenomena: For example, when feeling excited, afraid, in stressful situations or even in love, it may feel as if the heart is "fluttering". In addition to this, fluttering of the heart can also indicate a disease and, for example, be an expression of a cardiac arrhythmia, i.e. an irregular sequence of the normal heartbeat. This can occur in healthy people and be harmless, as well as a forerunner and warning sign of impending sudden cardiac death - that is why a precise clarification of the causes by a cardiologist or internist is particularly important here. In this context, the term "cardiac flutter" is often used synonymously for "atrial flutter" or "ventricular flutter", which is no longer a felt "flutter", but may be very dangerous forms of cardiac arrhythmia that do not require immediate treatment can quickly lead to cardiovascular failure with respiratory and cardiac arrest.


A "fluttering" heart can feel very different for those affected. It is often said that there is a feeling that the heart is beating “wrong”, sometimes accompanied by problems with breathing, dizziness, or sweating. In other cases, a kind of heartache or vibrating in the area of ​​the heart is reported, which feels as if you have just been very terrified. It can also happen that people feel a feeling that something is fluttering in the trachea or below the larynx. How long the fluttering of the heart lasts is also individual, in many cases it only lasts a few seconds per episode, but occurs again and again throughout the day. Sometimes there is chest pain and / or anxiety. This could be evidence of a heart attack.

Causes of fibrillation

If the heart flutters during stress, fear, panic or before meeting the new girlfriend, this is a completely normal reaction of the body, because the feeling of excitement and falling in love represents a biochemically stressful situation for the body. In the course of this, the body becomes in both cases put on "alert", which leads to a rapid release of the hormone adrenaline by the so-called sympathetic nervous system, a part of the vegetative nervous system. Adrenaline, which releases glucose and free fatty acids from the energy stores of the liver, muscles and adipose tissue, increases blood pressure, heart rate and respiratory rate.

In addition, there are other symptoms such as increased sweating or increased muscle tension. So that this natural and harmless form of fluttering heart does not become harmful to the organism, those affected should find a way to relax. Then the “resting or relaxation nerve” parasympathetic nervous system is activated, which acts as a “counterpart” to the sympathetic nervous system by ensuring that the energy supply is shut down, which gives rise to a feeling of relaxation and the cardiac flutter subsides.

Irregular heartbeat (arrhythmia)

In addition to excitement or falling in love, a cardiac arrhythmia can also be the cause of the heart fluttering. This is understood to mean an irregular sequence of the normal heartbeat, which is normally about 60 to 80 times per minute in the idle state. Cardiac arrhythmias occur very frequently, although these are often not even noticed in light or occasional versions. Arrhythmia comes from both external causes such as excessive consumption of caffeine or alcohol, side effects of some medications (e.g. antidepressants), febrile infections or a bloated stomach (meteorism).

Irritation of the so-called "carotid sinus node" (receptor on the main artery on the neck) - for example, due to a scarf that is too tight or a blow - can possibly lead to a cardiac arrhythmia, since the irritation slows the heartbeat, which can lead to Fainting. In addition to the external causes, a number of organic causes can also be responsible for an arrhythmia, such as coronary heart disease (CAD), a heart attack, a heart muscle disease or myocarditis. In addition, hyperthyroidism (hyperthyroidism) or hypothyroidism (hyporthyroidism), high blood pressure or electrolyte imbalance (e.g. potassium deficiency) can be considered.

There are many forms of cardiac arrhythmia, for example the so-called irritation disorders, in which the formation of the electrical impulses is disturbed or the "conduction disturbances", which means an impaired transmission of the heart's excitation. Arrhythmias are also classified according to whether they originate in the area of ​​the atria (supraventricular) or in the ventricles (ventricular). In addition, a distinction is made between a slow heart rate (bradycardia) with less than 60 beats per minute and a heart that beats too fast with over 100 beats per minute (tachycardia). Another form of cardiac arrhythmia is additional heartbeats (extrasystoles), which are also known as "heart stumbling".

Cardiac arrhythmias occur quite frequently overall and can be completely harmless in healthy people as well as in the form of a pathological or even life-threatening complication in diseases of the heart and other organs. Therefore, frequent or persistent cardiac flutter should always be examined by a doctor.

Chamber flutter

The term "cardiac flutter" is often used synonymously for the so-called ventricular flutter, which is no longer primarily a felt "fluttering" of the heart, but a very dangerous form of cardiac arrhythmia, which quickly occurs without immediate treatment leads to death. Ventricular flutter is characterized by a frequency of 250 to 300 beats per minute, which means that the heart has completely lost its rhythm and instead works without a recognizable beat and at a very high speed. As a result, the uneven contraction of the individual muscle fibers means that the blood can no longer be pumped from the ventricle into the circulation, but only moves back and forth in the heart - which corresponds to the situation of cardiac arrest with regard to the actual function of the heart.

In most cases, ventricular flutter is caused by a heart attack or other serious heart disease that has led to a change in the structure of the heart or a functional impairment. Examples include coronary artery disease (CAD), heart failure (heart failure), dilatation (overstretching) or an aneurysm, heart attacks and cardiac inflammation (e.g. myocarditis).

In addition to the direct diseases of the heart, changes in the electrolyte balance can promote the occurrence of ventricular flutter, in particular hypokalaemia (potassium deficiency) or hypomagnesaemia (magnesium deficiency). In rare cases, electrical accidents, strokes or heart trauma (e.g. due to traffic accidents) can also cause ventricular flutter. Ventricular flapping often leads to loss of consciousness within a short period of time, possible pre-symptoms can also be pain and tightness in the chest, rapid heartbeat, dizziness and acute shortness of breath.

In most cases, ventricular flutter quickly changes to what is known as ventricular fibrillation, which means a heartbeat rate of over 300 per minute, which leads to cardiovascular failure with respiratory and cardiac arrest. Since the brain is no longer adequately supplied with blood due to the extremely high stroke rate, it quickly becomes unconscious, as a result the patient is no longer responsive and no longer responds to pain and light stimuli, which means that the pupils are dilated and rigid . Accordingly, ventricular flutter or ventricular fibrillation are extremely threatening conditions that can be fatal if they are not treated correctly immediately.

Atrial flutter

In addition to ventricular flutter, the so-called atrial flutter is also colloquially referred to as “cardiac flutter”, which is also a sometimes more severe form of cardiac arrhythmia. With this disorder, the sinus node, which is located in the right atrium of the heart, has lost its primary function as an "electrical clock" for the heart action, so that it leads to a fast but regular heart rhythm in the atrium with an atrial rate of around 240 to 350 heart actions per minute is coming. In rare cases, atrial flutter can also become life-threatening, since the atria of the heart no longer pump properly but actually only “flutter” and blood clots form in the heart sockets. In an emergency, these can come loose and be flushed into the brain with the bloodstream, which can lead to a stroke with paralysis, speech disorders or even death.

In many cases, atrial flutter leads to a seizure-like racing heart and / or severe palpitations or stumbling, or the feeling that the heart is beating "up to the neck". These symptoms are sometimes accompanied by other symptoms such as dizziness, chest tightness, shortness of breath, rapid fatigue and general physical weakness. Atrial flutter often occurs as a result of atrial stretching and / or other damage to the heart. In many cases, however, other diseases are also the cause of atrial flutter, for example high blood pressure, coronary heart disease and heart attack, heart valve diseases, diseases of the heart muscle (cardiomyopathy) such as an inflammation of the heart muscle (myocarditis) or an overactive thyroid.

In rare cases, atrial flutter can also occur in otherwise heart-healthy patients. This can be fostered, among other things, by emotional stress, excessive consumption of alcohol and coffee, consumption of nicotine and drugs, as well as opulent meals and a lack of minerals (especially potassium and magnesium). Nevertheless, most patients have organic heart diseases.

With regard to diagnosis and treatment, atrial flutter differs only slightly from the much more common cardiac arrhythmia, which affects about 300,000 people in Germany alone. Atrial fibrillation is characterized by a persistent irregular, usually significantly faster heartbeat and other symptoms such as sudden weakness, shortness of breath or heartache. Although this form of arrhythmia is not life-threatening, atrial fibrillation also poses serious risks, since complications such as a stroke or heart failure can result from blood clots. There are also numerous causes for atrial fibrillation, such as a long-standing hypertension, old age, cardiac muscle weakness, coronary heart disease, diabetes (diabetes mellitus), heart valve defects or an inflammation of the heart muscle.


If there is a cardiac arrhythmia as the cause of the fluttering of the heart, this can first be recognized by the changed pulse. In most cases, the doctor can already tell whether the heart is beating too slowly (bradycardia), too fast (tachycardia) or irregularly (arrhythmia). Furthermore, the medical examination usually asks for medication taken as part of the medical history, since some preparations (e.g. thyroid hormones) can also cause cardiac arrhythmias if the dosage is incorrect.

However, the most important examination for suspected cardiac arrhythmias is electrocardiography (ECG), which measures the electrical currents in the heart. The heart activity is shown as a curve, which provides the doctor with information on what type of rhythm disturbance it is. As part of the diagnosis, this ECG is then first performed under resting conditions (resting ECG).

If necessary, the examination is then supplemented by a stress ECG (ergometry). The heart activity is measured under stress conditions (for example, when cycling or running on a treadmill), since some rhythm disturbances only occur under stress. In addition, a long-term ECG can provide information about 24 to 48 hours, because many cardiac arrhythmias occur only occasionally. Such sporadic cardiac arrhythmias can also be recorded using an "event recorder", which is used, for example, when a long-term ECG has not provided sufficient results.

In most cases, these examinations are sufficient to diagnose a cardiac arrhythmia, in special cases, however, an "electrophysiological examination" is carried out. This is a special cardiac catheter examination that artificially triggers cardiac arrhythmias, if possible, in order to be able to draw conclusions about the type and location. In addition, further tests can be considered for special questions, such as an ultrasound examination of the heart (echocardiography), which can provide information about heart valve defects and cardiac insufficiency, or magnetic resonance imaging (MRI) through which coronary heart disease (abnormal change in the coronary arteries) can be uncovered.

The main characteristic of ventricular flapping is the pulseless loss of consciousness, so only an electrocardiogram (EKG) is required for diagnosis. Chamber flutter is characterized by 250 - 300 excitations per minute, the EKG lines look like hairpins. With ventricular fibrillation there are more than 300 excitations per minute - here the ECG lines are more reminiscent of smaller and larger disordered waves.

If there is an atrial flutter, the diagnosis is made through a detailed medical history and clinical examination as well as an ECG, long-term ECG or, if necessary, a stress ECG. Atrial flutter is easy to diagnose due to its characteristic electrocardiographic appearance, since the ECG zero line is deformed "like a saw blade". Since there is an increased risk of stroke with atrial flutter, a so-called TEE examination (trans-esophageal echocardiography) is usually carried out first. An ultrasound head is placed in the esophagus up to the level of the atria in order to exclude blood clots in the heart.

It is not uncommon for a doctor to be unable to find organic causes for the heart problems. Therefore, the diagnosis is often “functional heart problems” or cardiac neurosis. The causes are unprocessed fears, worries or stress. In such a case, cognitive behavior therapy can help.

Treatment options

If a cardiac arrhythmia was diagnosed as the cause of the fluttering of the heart, the treatment is based on the causal factors or diseases. Accordingly, the underlying disease (e.g. coronary heart disease or thyroid dysfunction) must be treated in the first step and risk factors (such as overweight, drug consumption, high blood pressure) minimized or eliminated. There are very different approaches in therapy, which is the right one in individual cases, depends primarily on the type of rhythm disorder, but also on the possible consequences of the treatment.

Medications for cardiac arrhythmias (antiarrhythmics) can be used, such as the so-called “sodium channel blockers” or “beta receptor blockers”. These have an effect on the cardiac conduction system and thus influence the rhythm of the heart.For some types of cardiac arrhythmia (e.g. atrial fibrillation), special anticoagulant drugs are also required to prevent blood clots from forming. Defibrillation and cardioversion are used as emergency therapy for life-threatening cardiac arrhythmias, in which normal heart activity is to be restored by strong current surges.

If drug therapy in the treatment of cardiac arrhythmia remains unsuccessful, there are other proven and safe treatment methods, such as catheter ablation - in which the area responsible for the arrhythmia is obliterated with the help of high-frequency current and the cause is specifically eliminated.

In addition, the implantation of a pacemaker replaces or bridges the defective stimulation system in certain forms of cardiac arrhythmia (for example atrial fibrillation), especially if the heart beats too slowly. The flat pacemakers, a few centimeters in size, are implanted at the level of the collarbone, which always emit a weak current pulse when the heart beats too slowly or irregularly.

If there is ventricular flutter, treatment depends on the severity of the arrhythmia. If the patient is responsive and his pulse is still palpable, the therapy is usually medicated. In many cases, however, ventricular flutter is an absolute emergency, since ventricular fibrillation quickly arises, which can be fatal after only a few minutes. Since the patient usually becomes very quickly unconscious due to insufficient blood supply to the brain in ventricular flutter, in this case the emergency doctor immediately begins to resuscitate (resuscitation) by means of electroshock (defibrillation), the success or failure of which can be immediately recognized by the ECG and the patient's reaction is. After a successful resuscitation, the heart rhythm is stabilized with medication (usually with beta-blockers) to prevent ventricular flutter / ventricular fibrillation.

In the case of atrial flutter, drug therapy is used in many cases, depending on the case, whether the reduction in the speed of cardiac actions ("frequency control") or the regulation of atrial flutter or the transition to a normal, regular heartbeat, the so-called sinus rhythm is in the foreground ("rhythm control"). In view of the increased risk of stroke, blood thinning is also necessary for most patients.

If the atrial flutter occurs only rarely, but continues for a long time, an electrical cardioversion ("electroshock") can be used to restore the normal rhythm - however, since this therapy only serves to end the acute heartbeat, the cardiac arrhythmia occurs later on in most cases. For this reason, the obliteration of certain heart muscle cells in the right antechamber is mostly considered an established and safe method for permanent removal of atrial flutter (catheter ablation). The procedure is performed under local or general anesthesia; the scars that develop during catheter ablation heal in about two to four months, during which time the electrical properties of the heart normalize again. In principle, atrial flutter can no longer occur after successful sclerotherapy; the chances of success are around 90-95%, while the complication rates are very low.

Cardiac arrhythmias, however, are not always in need of treatment; instead, patients suffering from cardiac flutter have many options of their own influence by avoiding or minimizing the factors that can trigger or exacerbate the disorders. These include smoking, alcohol, caffeine and lack of sleep. In addition, care should be taken to ingest sufficient electrolytes (especially potassium, magnesium), especially in the case of fever, excessive sweating or treatment with diuretics. Here, however, food supplements should not be used without further ado, rather the natural route via potassium suppliers such as bananas, dried fruit, potatoes and fennel is suitable. A lot of magnesium is also contained in legumes, grains and nuts.

In principle, an attempt should be made to avoid any form of stress as much as possible, because although this is not considered to be the cause of cardiac arrhythmia, it can trigger and exacerbate it - which is particularly true for the frequently occurring atrial fibrillation. Accordingly, you should try to achieve relaxation in moments when the heart flaps uncomfortably. Breathing exercises or other relaxation techniques such as autogenic training or tai chi, which can be used to quickly reduce physical arousal, are particularly suitable for this.

Naturopathy for flapping hearts

If serious illnesses for the fluttering of the heart could be excluded, the targeted use of naturopathic methods offers a sensible alternative to alleviate the symptoms. In many cases, relaxing baths and rubbing in with lavender, spruce oil or copper ointment have proven their worth in many cases to relax and strengthen the cardiovascular system. A lavender overlay is also often helpful: the natural doctor Dr. Anke Görgner to use a mixture of jojoba or almond oil and lavender oil in a ratio of 1:10 (for example, mix 100 ml almond oil and 10 ml lavender oil). A gauze compress is soaked in the oil mixture and then placed on the area of ​​the heart, the compress should remain on the body for about an hour. According to Dr. It is best for Anke Görgner to use this method during the afternoon nap or before falling asleep.

In addition to this, homeopathy can also help with mild forms of cardiac flattening, whereby it should be noted here that homeopathic remedies should never be used on your own for heart problems, but only in consultation with or under the supervision of a doctor or experienced alternative practitioner. Aconitum napellus (the blue monkshood) is used here, which is one of the strongest remedies in homeopathy and, among other things, has a particularly strong relationship to the cardiovascular system. Unless diluted homeopathically, aconite is highly toxic, therefore the drug is prescription-only in Germany up to and including D3 and, accordingly, must not be manufactured or taken without supervision.

In addition, Crataegus is used for general heart strengthening, digitalis purpurea is also often used, which is one of the most popular homeopathic remedies in the treatment of mild cardiac arrhythmias, since it can be used both as a preventive measure and for the treatment of an existing cardiac arrhythmia.

Schüssler salts are also suitable for the treatment of cardiac arrhythmias. Here, for example, Manganum sulfuricum D6 (No. 17) or Kalium phosphoricum D6 (No. 5) are used for inner restlessness and nervousness, rapid heartbeat or stumbling. Added to this are magnesium phosphoricum D6 (No. 7) or potassium phosphoricum D6 (No. 5), which are often used in alternative medicine in the case of rapid heartbeat during stress and stress.

The area of ​​phytotherapy (herbal medicine) also offers a wide range of applications for cardiac arrhythmias. If the fluttering of the heart occurs particularly when there is fear or nervousness, medicinal plants such as passion flower, valerian, St. John's wort, lemon balm or hops are often used. In addition, hawthorn (Crataegi folia) is used for various heart complaints, which is said to improve cardiac output and enlarge the coronary vessels. In addition, this can help stabilize the heart's rhythm and lower blood pressure, with an optimal effect usually only showing after four to six weeks. In the case of mild rhythm disturbances, broom herb (Spartium scoparium) is also suitable for treatment, especially if there is increased irritability and excitability, because the Spartium scoparium slows down the conduction of the stimulus and thereby reduces accelerated heart excitation.

Author and source information

This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.

Dipl. Social Science Nina Reese


  • German Center for Cardiovascular Research e. V .: Cardiac arrhythmia, (accessed October 6, 2019), DZHK
  • L. Brent Mitchell: Overview of Arrhythmias, MSD Manual, (accessed October 6, 2019), MSD
  • Lothar Krehan: Cardiac arrhythmia, Lehmanns Verlag, 1st edition, 2017
  • Erdmann: Clinical Cardiology, Springer Verlag, 8th edition, 2011
  • L. Brent Mitchell: Atrial Fibrillation and Atrial Flutter, MSD Manual, (accessed October 6, 2019), MSD

ICD codes for this disease: I49ICD codes are internationally valid encryption for medical diagnoses. You can find e.g. in doctor's letters or on disability certificates.

Video: What is an Atrial Flutter? Rapid Heart Contractions (December 2022).