What’s Causing that Fluttering in Your Chest?

Heart palpitations cause that fluttery feeling

Do scary movies make your heart skip a beat? Or maybe you notice a weird fluttering feeling in your chest just as you’re settling down for the night.

“When your heart beats rapidly or irregularly for a few seconds, you might feel this odd sensation in your chest, neck or throat,” says Pugazhendhi Vijayaraman, MD, a Geisinger cardiac electrophysiologist.

This feeling is a symptom of heart palpitations. It’s sometimes described as thumping, vibrating, or a heart that’s racing, flip-flopping or skipping a beat. Most of the time, this isn’t cause for concern, but it’s always best to work with your doctor to eliminate potential heart conditions.

What causes fluttering in the chest?

Heart palpitations are common, affecting people across various demographics. Though they can happen in healthy people, specific groups like older adults, those with existing heart conditions and people with high stress or anxiety levels report these sensations more often.

Some common causes of heart palpitations include:

Alcohol
Anxiety
Asthma medications
Caffeine
Dehydration
Hormonal changes like pregnancy, perimenopause and menopause
Metabolism changes like low blood sugar or thyroid issues
Nicotine
Some cold and cough medications
Strenuous exercise

Anxiety is a common cause of palpitations, and you’ll probably notice the feeling right before a nerve-wracking event like a first date or big presentation at work. This side effect might be accompanied by an upset stomach or sweaty palms.

But what about when the flutter happens with no obvious trigger, like when you’re about to fall asleep?

"People often notice heart palpitations at night because there are fewer distractions competing for their attention,” explains Dr. Vijayaraman. “They might be happening throughout the day, but you’re too busy to notice.”

Preventing palpitations

An occasional fluttering in your chest usually resolves on its own or with simple lifestyle changes.

Dr. Vijayaraman offers the following tips to deal with heart palpitations:

Incorporate relaxation techniques like meditation, yoga or deep breathing.
Make sure you’re drinking enough water throughout the day.
Cut back on or eliminate stimulants like caffeine and nicotine.
Lower your alcohol intake.
Ask your doctor or pharmacist if any of your medications might cause palpitations.
If you’re approaching or going through menopause or other hormone changes, talk to your doctor about your symptoms.

Could fluttering in your chest be AFib?

If the feeling lasts more than a few seconds at a time, increases in frequency, or if you know you have an existing heart condition, it could be atrial fibrillation, or AFib.

“During atrial fibrillation, upper heart chambers called atria flutter or fibrillate, meaning they beat at very fast rates,” says Dr. Vijayaraman. This results in irregular beating of the lower chambers called the ventricles.

“This pattern isn’t efficient, allowing blood to pool and form clots. Once the clots leave the heart, they can cause stroke,” says Dr. Vijayaraman. “Patients with AFib are 5 times more likely to have a stroke than those without it.”

Other symptoms of AFib include:

Dizziness
Shortness of breath
Weakness or general fatigue
Chest pain

For some people, AFib lasts a few days at a time and their heartbeat returns to normal. For others, AFib can last longer or become chronic. Whether the flutters are short-lived or become permanent, AFib increases the risk of stroke and heart failure.

And some people who have AFib don’t have heart flutters or other symptoms at all.

“Occasionally, a patient will be diagnosed with AFib during a routine checkup,” notes Dr. Vijayaraman. “That’s why it’s so important to see your doctor regularly, especially as you age.”

If you’re older than 65 and have health conditions like high blood pressure, diabetes, heart disease or are overweight, you may be at increased risk for AFib. Talk to your doctor about ways to monitor your heart health over time. For example, many wearable fitness trackers or smart watches can track your heart rate and even record electrocardiogram results directly to your phone.

When to see a doctor

Talk to your doctor if you notice fluttering in your chest more frequently or other signs like fainting, shortness of breath or lightheadedness.

“They can monitor your heartbeat, conduct tests like an electrocardiogram or have you wear a portable heart monitor for several days,” says Dr. Vijayaraman. “Understanding your family health history and any health conditions can also help your doctor accurately diagnose your irregular heartbeat.”

So, next time your heart skips a beat, take notice. Whether it’s from that extra shot of espresso or skipping breakfast, knowing the cause can help give you peace of mind.