Heart stumbling

What is heart stumbling?

If there is an extra heartbeat that is out of the normal heart rhythm, we refer to this as extrasystoles, also known in common parlance as heart stumbles.

The excitation of the heart always follows the same pattern and is conducted once through the entire heart. The excitation is generated by the so-called sinus node, then passed on via the atria to the atrioventricular node and subsequently stimulates the ventricles. In contrast, an extrasystole is created in the heart muscles independently of this and has no effect on the excitation loop.

Heart palpitations can be perceived as very frightening and patients may find them difficult to deal with. Many people are afraid of having a heart condition. Particularly at rest, extrasystoles are often felt more distinctly and are more worrying. 

Officially, heart stumbling is a type of cardiac arrhythmia. It involves one or more heartbeats that happen earlier and are therefore perceived as arrhythmic. The extra heartbeats are usually harmless, but a structural heart disease may be the cause of the symptoms.

What causes heart stumbling?

There can be many different reasons for heart stumbling. The most common causes are fatigue and stress. Excessive caffeine or alcohol intake also contributes to the occurrence of cardiac arrhythmia.

Tension

Tense back muscles and a blocked cervical and thoracic spine can place stress on the heart and cause extrasystoles. A targeted back workout and physiotherapy can help to relieve the patient.

Heart stumbling for psychological reasons / stress

Another important factor are mental states of tension, psychological strain and social and occupational stress. Your body can react to mental tension with heart stumbling and palpitations.

Electrolyte imbalances

During exercise or heavy sweating, for example in a sauna, changes in electrolytes can affect the work of the heart. The heart's activity is based on a shift of electrolytes between the intracellular and extracellular space. If heavy sweating leads to a loss of electrolytes during sport or sauna visits, this can result in an extra heartbeat.

Heart stumbling as a late complication of corona (post-COVID)

After a Covid infection, some patients experience prolonged fatigue, weakness, heart stumbling and other cardiac symptoms. The precise pathophysiological background has not yet been fully explained.

Patients report palpitations, heart stumbling and chest tightness. Those with pre-existing heart disease are at an increased risk of developing these symptoms. Nonetheless, heart stumbling and limited exercise tolerance also occur in young, previously fit patients. Usually the symptoms improve again after a few months and serious damage is very rare. However, these symptoms should be investigated by a cardiologist.

Thyroid gland

Another reason for the heart stumbling can be a disease of the thyroid gland. In particular, hyperthyroidism with increased production of thyroid hormones can trigger palpitations and extrasystoles. A blood test for thyroid hormones is done to detect hyperthyroidism or hypothyroidism. Thyroid disorders can be treated with medication.

What are the typical symptoms of heart stumbling?

Extrasystoles are often perceived only as an additional or delayed heartbeat. They can also be accompanied by palpitations, nausea or dizziness. Some patients feel light-headedness and anxiety or restlessness. In rare cases, chest pain may also occur.

How dangerous is heart stumbling?

In the majority of cases, heart stumbling is harmless. The occasional occurrence of extrasystoles is completely normal and should not be considered a clinical condition as such. However, if patients experience heart stumbles very frequently or if they find the symptoms very distressing, a cardiologist should be consulted. Especially if there are additional symptoms such as malaise, nausea, very frequent palpitations or chest pain, you should always seek medical advice. After all, extrasystoles can be the first indication of a structural heart condition or other cardiac arrhythmias.

Especially if you have additional chest pain, pain radiating into the arm, cold sweats or intense stomach or back pain, you should visit a hospital immediately for an assessment. Rarely, a heart attack may be the cause of the symptoms.

Diagnosis of cardiac arrhythmia

The diagnosis is made as part of a cardiological examination. First of all, an ECG is written in order to visualize the extrasystoles.

Further tests such as cardiac echography may also be required to rule out structural heart disease. The ECG examination as well as the cardiac echo can also be repeated under stress. To do so, the patient is asked to work out on an ergometer while the ECG is being recorded.

This enables stress-dependent changes to be recorded.

If there is evidence of structural heart disease, further imaging procedures are used.

Therapy and treatment for heart stumbling

Harmless heart stumbling generally does not require treatment. Initially, the best therapy concept is lifestyle change.

In most cases, reducing caffeine or nicotine intake and getting enough sleep can provide relief. Reducing stress and practicing ways of coping with stress are also important factors in preventing extrasystoles.

If patients are very distressed and extrasystoles occur frequently, they can be treated with medication.

The drugs used are antiarrhythmic drugs, mainly so-called beta-blockers, which help to keep the heart rhythmic. Even simple mineral supplements can be taken.

Structural heart diseases like atrial fibrillation, myocarditis, heart valve defects or a narrowing of the coronary arteries should always be ruled out first.

If the heart stumble fails to respond to the medication listed, then heat therapy can be applied to the area triggering the stumble if the patient is very severely affected or if the pumping function of the heart is disturbed by the extrasystoles.

This procedure is performed in the cardiac catheterization laboratory and can only be done if the extrasystoles are always coming from the same source in the heart.

Heart stumbling: Which doctors & clinics for heart problems?

First of all, you can consult your family doctor. Should further investigations be needed, you will then be referred to a cardiology practice or clinic.

If you're in need of a doctor, you expect the best medical care possible. So of course patients are curious to find out what clinic to go to. As there is no objective way to answer this question and a legitimate doctor would never claim to be the best, patients must rely on a doctor's experience.

Let us help you find an expert for your condition. All listed doctors and clinics have been reviewed by us for their outstanding specialization in the field of heart stumbling and are looking forward to your inquiry or wish for treatment.

Sources: 

• Duale Reihe Innere Medizin. Arastéh K, Baenkler H, Bieber C, Brandt R, Chatterjee T, Dill T, Ditting T, Duckert M, Eich W et al., Hrsg. 4., überarbeitete Auflage. Stuttgart: Thieme; 2018. doi:10.1055/b-005-145255 
• Sportherz und Herzsport. Berrisch-Rahmel S, Rost C, Stumpf C, Hrsg. 1. Auflage. Stuttgart: Thieme; 2020. doi:10.1055/b-004-132237 
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