Why Your Heart Skips a Beat, Heart Flutters Explained

Heart Flutters and Changes in Heart Rate: Understanding, Managing, and Supporting Your Heart Health

Many patients ask about heart flutters, palpitations, and changes in heart rate—sensations that can be both unsettling and confusing. This newsletter is designed to help you understand what these symptoms mean, what causes them, and how you can safely manage them. We’ll also explore how osteopathic manual therapy can support your nervous system and heart health, working alongside your medical care.

What Are Heart Flutters, Palpitations, and Heart Rate Variability?

Understanding Heart Flutters and Palpitations

Heart flutters and palpitations are terms often used interchangeably, but they have subtle differences. A palpitation is the sensation of your heart beating unusually—perhaps skipping a beat, pounding, racing, or fluttering. You might feel this in your chest, throat, or neck. Palpitations can happen during activity, rest, or even sleep, and are usually brief, lasting seconds to minutes. Most are harmless, but persistent or severe palpitations should be evaluated by a healthcare provider.

A heart flutter is a specific type of palpitation. It often refers to a rapid but regular heartbeat caused by abnormal electrical activity in the heart’s upper chambers (the atria). The most common type is atrial flutter, where the atria beat very quickly—sometimes 250–350 times per minute. This can feel like a fast, steady, rhythmic pounding in your chest. Unlike simple palpitations, flutters may last longer and can be more serious, especially if you have underlying heart disease.

Key symptoms of palpitations and flutters include:

• Rapid, pounding, or fluttering heartbeat

• Skipped or extra beats

• Sensation of the heart “flip-flopping” or racing

• Sometimes dizziness, lightheadedness, or shortness of breath

While most palpitations are benign, seek medical attention if you experience chest pain, fainting, or prolonged rapid heartbeats.

What Is Heart Rate Variability (HRV)?

Heart Rate Variability (HRV) is a measure of the variation in time between each heartbeat. Rather than beating like a metronome, a healthy heart naturally speeds up and slows down in response to breathing, activity, and stress. HRV is a window into your autonomic nervous system—the body’s automatic regulator of heart rate, digestion, and more.

• High HRV generally indicates a flexible, resilient heart and nervous system, able to adapt to stress and recover quickly.

• Low HRV may reflect chronic stress, fatigue, or underlying health issues, and is associated with increased risk for heart problems.

Why does HRV matter? It’s a marker of how well your body balances “fight or flight” (sympathetic) and “rest and digest” (parasympathetic) responses. Improving HRV is linked to better cardiovascular health, stress resilience, and emotional well-being.

Ten Common Causes of Heart Flutters and Palpitations

Heart flutters and palpitations can be triggered by a wide range of factors. Understanding these can help you identify your own triggers and take steps to reduce symptoms.

1. Stress and Anxiety

How it triggers flutters: Emotional stress and anxiety activate your body’s “fight or flight” response, releasing adrenaline and other stress hormones. This speeds up your heart rate and can cause palpitations or flutters. Panic attacks can also trigger intense, rapid heartbeats, sometimes mistaken for a heart attack.

What you might feel: Racing, pounding, or fluttering heart; sweating; chills; chest discomfort; shortness of breath.

Why it matters: Up to 31% of adults experience palpitations due to anxiety. Chronic stress can lower HRV and increase risk for heart rhythm problems.

2. Caffeine and Stimulants

How it triggers flutters: Caffeine (in coffee, tea, energy drinks, chocolate) is a stimulant that increases heart rate and blood pressure. Some people are more sensitive than others, and even small amounts can trigger palpitations or flutters. Nicotine and certain cold medications can have similar effects.

What you might feel: Heart racing, pounding, or skipping beats, especially after caffeine or stimulant use.

Why it matters: While moderate caffeine is safe for most, those with heart rhythm issues or high sensitivity should limit intake.

3. Dehydration and Electrolyte Imbalances

How it triggers flutters: When you’re dehydrated, your blood volume drops and your heart works harder to pump blood. Electrolytes (like potassium, magnesium, sodium) are essential for normal heart rhythm. Imbalances can cause palpitations or irregular beats.

What you might feel: Fluttering, pounding, or skipping beats, especially after sweating, vomiting, or not drinking enough fluids.

Why it matters: Dehydration and electrolyte loss are common triggers, especially in hot weather or during illness.

4. Alcohol and “Holiday Heart” Syndrome

How it triggers flutters: Binge drinking or even moderate alcohol intake can disrupt the heart’s electrical system, leading to atrial fibrillation (“holiday heart syndrome”) or palpitations. This is especially common during holidays or celebrations.

What you might feel: Rapid, irregular, or fluttering heartbeat, sometimes with fatigue or shortness of breath.

Why it matters: Alcohol-induced arrhythm can be serious, especially in those with underlying heart disease.

5. Premature Beats (PVCs, PACs) and Benign Ectopy

How it triggers flutters: Premature ventricular contractions (PVCs) and premature atrial contractions (PACs) are extra heartbeats that disrupt the normal rhythm. They’re common and usually harmless, but can feel like a flutter, skipped beat, or thump.

What you might feel: Fluttering, pounding, or “flip-flopping” sensation in the chest.

Why it matters: Frequent or bothersome PVCs/PACs should be evaluated, especially if you have heart disease.

6. Thyroid and Hormonal Influences

How it triggers flutters: Thyroid hormones regulate metabolism and heart rate. Overactive thyroid (hyperthyroidism) or high doses of thyroid medication can cause palpitations, rapid heart rate, and arrhythmias. Hormonal changes during pregnancy, menstruation, or menopause can also trigger symptoms.

What you might feel: Racing or irregular heartbeat, sometimes with weight loss, anxiety, or heat intolerance.

Why it matters: Thyroid-related palpitations often resolve with proper treatment.

7. Medications and Over-the-Counter Drugs

How it triggers flutters: Many prescription and OTC drugs can affect heart rhythm. Common culprits include asthma inhalers, decongestants, certain antidepressants, thyroid medications, and some antibiotics. Supplements like ginseng or bitter orange can also be triggers.

What you might feel: Palpitations, rapid or irregular heartbeat, sometimes with dizziness or chest discomfort.

Why it matters: Always check with your doctor or pharmacist if you notice new symptoms after starting a medication.

8. Low Blood Sugar and Metabolic Triggers

How it triggers flutters: When blood sugar drops (hypoglycemia), your body releases adrenaline to raise it. This can cause a racing heart, palpitations, sweating, and anxiety. Skipping meals, heavy exercise, or diabetes medications can all be triggers.

What you might feel: Shakiness, sweating, hunger, rapid heartbeat, anxiety, or confusion.

Why it matters: Frequent lows should be discussed with your healthcare provider, especially if you have diabetes.

9. Illicit Drugs and Stimulants

How it triggers flutters: Cocaine, amphetamines, ecstasy, and other street drugs are powerful stimulants that can cause dangerous arrhythmias, high blood pressure, and even sudden cardiac death.

What you might feel: Rapid, irregular, or pounding heartbeat, chest pain, dizziness, or fainting.

Why it matters: These are medical emergencies—seek help immediately.

10. Cardiac Causes—Arrhythmias and Structural Heart Disease

How it triggers flutters: Sometimes, palpitations or flutters are due to underlying heart conditions like atrial fibrillation, supraventricular tachycardia, heart valve problems, or cardiomyopathy. These may require specific medical treatment.

What you might feel: Persistent or severe palpitations, chest pain, shortness of breath, fainting, or swelling in the legs.

Why it matters: If you have risk factors (age, high blood pressure, diabetes, heart disease), or if symptoms are severe, seek prompt medical evaluation.

Ten Safe, Evidence-Informed Ways to Manage or Reduce Heart Flutters

Managing heart flutters and palpitations often starts with identifying and addressing triggers. Here are ten strategies, each supported by research and clinical experience:

1. Hydration and Electrolyte Correction

Why it helps: Staying well-hydrated and maintaining balanced electrolytes supports normal heart rhythm. Drink enough water so your urine is pale yellow, and consider electrolyte-rich foods (bananas, leafy greens, nuts) or drinks if you’re sweating heavily or ill.

How to do it: Sip water throughout the day; add a pinch of salt or use electrolyte tablets if needed. Avoid overconsumption of sports drinks high in sugar.

2. Vagal Maneuvers and Vagus Nerve Stimulation

Why it helps: The vagus nerve is a key part of the parasympathetic (“rest and digest”) system. Stimulating it can slow your heart rate and restore normal rhythm, especially for certain arrhythmias.

How to do it: Try the Valsalva maneuver (bearing down as if having a bowel movement), splash cold water on your face, cough forcefully, or practice deep, slow breathing. Always check with your provider before trying these if you have heart disease or other health concerns.

3. Breathwork and Paced Breathing (HRV Exercises)

Why it helps: Slow, deep breathing activates the parasympathetic system, increases HRV, and calms the heart. Techniques like box breathing (inhale 4 seconds, hold 4, exhale 4, hold 4) or coherent breathing (5–6 breaths per minute) are especially effective.

How to do it: Practice for 5–10 minutes daily, or whenever you feel palpitations. Focus on belly breathing and slow exhalations.

4. Stress Reduction and Mindfulness Techniques

Why it helps: Meditation, mindfulness, yoga, and relaxation exercises reduce stress hormones, lower heart rate, and improve HRV. Regular practice can break the cycle of anxiety and palpitations.

How to do it: Try guided meditation apps, gentle yoga, or simply sit quietly and focus on your breath. Even a few minutes a day can make a difference.

5. Reduce Stimulants—Caffeine, Nicotine, Alcohol

Why it helps: Cutting back on caffeine, nicotine, and alcohol can reduce palpitations, especially if you’re sensitive. These substances stimulate the sympathetic system and can trigger irregular heartbeats.

How to do it: Gradually decrease your intake, switch to decaf or herbal teas, and avoid energy drinks. Seek support for quitting smoking or reducing alcohol if needed.

6. Sleep Hygiene and Regular Exercise

Why it helps: Poor sleep increases stress and lowers HRV, while regular exercise strengthens the heart and improves nervous system balance. Both are linked to fewer palpitations.

How to do it: Aim for 7–9 hours of sleep per night, keep a consistent bedtime, and get at least 150 minutes of moderate exercise per week (walking, cycling, swimming).

7. Dietary Adjustments and Blood Sugar Control

Why it helps: Balanced meals with complex carbs, protein, and healthy fats help maintain steady blood sugar and prevent hypoglycemia-induced palpitations. Avoid skipping meals or eating excessive sugar.

How to do it: Eat regular, balanced meals; include snacks if needed; and monitor your response to different foods

8. When to Seek Medical Evaluation and Tests

Why it helps: While most palpitations are benign, some require medical attention. Red flags include chest pain, fainting, severe shortness of breath, or a history of heart disease.

How to do it: Keep a symptom diary (see resources below), note triggers, and share with your healthcare provider. Tests may include ECG, Holter monitor, blood work, or echocardiogram.

9. Medications and Medical Treatments (Overview)

Why it helps: For some, medications like beta-blockers, calcium channel blockers, or antiarrhythmics may be needed to control heart rhythm. Treating underlying conditions (thyroid, anemia, etc.) is also important.

How to do it: Always take medications as prescribed and discuss any side effects or concerns with your doctor.

10. Complementary Supports—Manual Therapy, Breathing, Vagal Work

Why it helps: Osteopathic manual therapy, massage, and other hands-on approaches can support nervous system regulation, reduce stress, and improve HRV. These therapies are best used alongside—not instead of—medical care.

How to do it: See a qualified osteopathic manual therapist for individualized assessment and treatment. Combine with breathwork and lifestyle changes for best results.

The Autonomic Nervous System: Your Heart’s Regulator

Sympathetic vs. Parasympathetic—The Heart’s Two “Gears”

Your heart is under constant control by the autonomic nervous system (ANS), which has two main branches:

• Sympathetic (“fight or flight”): Speeds up heart rate, increases blood pressure, and prepares your body for action. Activated by stress, excitement, or danger.

• Parasympathetic (“rest and digest”): Slows heart rate, promotes relaxation, and supports recovery. Dominant during rest, sleep, and calm states.

How does this affect heart rhythm? The balance between these two systems determines your baseline heart rate and how your heart responds to stress or relaxation. Too much sympathetic activity (from chronic stress, stimulants, or illness) can lead to persistent rapid heart rate (tachycardia) or palpitations. Too much parasympathetic activity can cause slow heart rate (bradycardia) or pauses.

Heart Rate Variability (HRV) is a direct measure of this balance. High HRV means your heart can adapt flexibly; low HRV means it’s stuck in one “gear,” often due to stress or illness.

Vagus nerve stimulation (through breathwork, cold exposure, or manual therapy) can shift your body into a parasympathetic state, calming the heart and mind.

How Osteopathic Manual Therapy May Support Nervous System Regulation

What Is Osteopathic Manual Therapy?

Osteopathic manual therapy (OMT) is a hands-on approach that uses gentle techniques to assess and treat restrictions in the body’s tissues—muscles, joints, fascia, and even the organs (viscera). The goal is to restore balance, improve circulation, and support the body’s natural healing processes.

Key techniques include:

• Craniosacral therapy: Gentle work on the skull, spine, and sacrum to support nervous system balance and fluid flow.

• Visceral manipulation: Gentle release of tension around internal organs to improve movement, blood flow, and nerve function.

• Soft tissue and joint mobilization:Addressing restrictions in muscles and joints to improve posture, breathing, and relaxation.

How Does Manual Therapy Influence the Nervous System and Heart?

Research shows that OMT can:

• Increase HRV, indicating improved parasympathetic (relaxation) activity.

• Reduce stress and cortisol levels, supporting overall nervous system health.

• Improve symptoms of musculoskeletal pain, which often co-exist with stress and palpitations.

• Support better breathing, posture, and circulation, all of which influence heart rhythm.

  
  

Mechanisms may include:

• Activation of gentle touch receptors (C-tactile fibers) that send calming signals to the brain.

• Release of tension in the chest, diaphragm, and neck, improving breathing and vagal tone.

• Enhanced interoception (body awareness), helping you recognize and respond to stress signals earlier.

What Does the Evidence Say?

• A 2024 randomized controlled trial found that heart-focused palpation (a form of OMT) significantly increased HRV and reduced heart rate in stressed adults with musculoskeletal pain, suggesting a shift toward parasympathetic dominance.

• Systematic reviews show that OMT can improve HRV, reduce pain, and support nervous system balance, especially when tailored to individual needs.

• Techniques like craniosacral therapy and visceral manipulation are associated with reduced stress, improved digestion, and better emotional well-being.

It’s important to note: While OMT can support nervous system regulation, it is not a replacement for medical evaluation or treatment when needed. It works best as part of a holistic, team-based approach.

Take-Home Messages

• Heart flutters and palpitations are common and usually benign, but persistent or severe symptoms require medical evaluation.

• The autonomic nervous system (sympathetic and parasympathetic) plays a central role in heart rhythm and HRV.

• Ten common causes include stress, stimulants, dehydration, alcohol, premature beats, hormonal changes, medications, low blood sugar, illicit drugs, and cardiac conditions.

• Ten safe management strategies include hydration, vagal maneuvers, breathwork, stress reduction, reducing stimulants, sleep and exercise, dietary adjustments, medical evaluation, medications, and complementary supports like manual therapy.

• Osteopathic manual therapy can support nervous system regulation, improve HRV, and reduce symptoms, but is always complementary to—not a replacement for—medical care.

• Keep a symptom diary, know your red flags, and work with your healthcare team for the best outcomes.