Extrasystoles (heart stumbling)

Synonyms in the broadest sense

Extra heartbeat, heart stumbling, ventricular extrasystoles, supraventricular extrasystoles, palpitations, palpitations


Extrasystole is a heartbeat that falls outside the normal heart rate into the normal beat. Extrasystoles are very common, even in healthy people. Usually extrasystoles go unnoticed or they express themselves as "heart stumbling or suspension". The place of origin of the extrasystole is divided into:

  1. Supraventricular extrasystole and
  2. Ventricular extrasystole

1. Supraventricular extrasystoles (SVES for short)

Individual supraventricular extrasystoles interspersed in the sinus-basic rhythm ( extraschäge outgoing from the forecourt ) are frequent and as a rule a harmless incidental finding. The cells that produce the "out of line" potential, lie in the forecourt. They are not part of the normal stimulation system, such as the sinus node. They are called ectopic excitation centers.


Heart stumbling is classified in the group of cardiac arrhythmias.

Heart stumbling can be based on several causes. It is caused by an abnormal activity of the ventricle, which leads to an extra (" extra ") heartbeat outside of the normal heart rate ( so-called extrasystole ).

In general, heart stumbling can proceed without any symptoms and even go unnoticed by the person concerned, but it can also lead to clearly noticeable symptoms.
Heart stumbling can be caused by an extrasystole that originates either in the atrium of the heart ( so-called supraventricular extrasystole ) or in the ventricle itself ( so-called ventricular extrasystole ).

Heart stumbling, which is the basis of a supraventricular extrasystole, is often not noticed by those affected and does not necessarily mean that there is a heart disease, because even with completely healthy people, they can occur.

People who are anxious about the extra heartbeats may respond with sweats, nervous discomfort, and increased heart rate.

In contrast, heart stumbling, which is produced by ventricular extrasystoles, is clearly perceived by those affected. Here it can come in connection with the heart stumbling to a clearly palpable and above all irregular heartbeat. The extra heartbeats can also be felt as particularly strong. Also, the feeling of a " boisterous heartbeat " can arise.
In addition, a feeling of shortness of air can occur as side effects. Those affected also report dizziness and drowsiness, and may feel tired and powerless, especially after strenuous exercise such as after exercise.

Chest pain or a feeling of tightness can also be a side effect. Again, people who are sensitive to the additional, noticeable heart beats may develop anxiety, which in turn may be associated with discomfort such as sweating, nervous restlessness and tremors. A subsequent panic attack can develop into fears of death and cause syncope . The psyche plays a bigger role on the body than the effect of the extrasystole itself.

Supraventricular extrasystoles usually produce no symptoms. Rarely, heart palpitations or heart stumbling.


As already described, extrasystoles can occur without any disease value. Mostly they are triggered in the healthy by excitement or eg by stimulants such as coffee, alcohol or nicotine. However, an extrasystole may also be an indication of heart disease. Sick cardiac cells are more likely to produce false potentials. If heart disease such as CHD (Coronary Artery Disease), myocarditis or heart attack is at risk, extrasystoles may also trigger dangerous persistent arrhythmia at the atrial and ventricular level, such as a sustained rapid heartbeat (tachycardia, see below).

Metabolic disorders such as hyperthyroidism can also lead to extrasystoles.


To diagnose the supraventricular extrasystoles, the long-term and the exercise ECG are used. The origin of the extrasystoles can only be clarified by an ECG. The long-term ECG can show whether there are persistent tachycardias in addition to individual extra tyroses. Usually, the patient is asked to record when he feels discomfort during the long-term ECG. Thus it can be determined whether the complaints and the extrasystoles occur simultaneously and thus a causal relationship may be assumed or whether further search for causes of the symptoms must be sought. The stress ECG can be used to determine if the extrasystoles are more likely to occur during physical exertion.

However, this diagnostic is not used in all cases. Only if the extrasystoles:

  1. occur frequently (eg over 30 times per hour)
  2. lead to symptoms
  3. or heart disease.

In the ECG, extrasystoles are usually recognized as narrow (ie normally shaped) QRS complexes that occur earlier in time. The previous P-wave may be larger than a normal P-wave. In a supraventricular extrasystole occurs after the additional QRS complex a so-called non-compensatory pause, ie the clock of the sinus rhythm is shifted.


Supraventricular extrasystoles, which occur in the healthy, are not in need of therapy. In the presence of heart disease, the therapy of this disease is the first priority. If the SVES triggers tachycardia or other cardiac arrhythmias, treatment is required in any case. Usually beta-blockers or potassium-magnesium preparations are used.
Read more about heart stumbling therapy

2. Ventricular extrasystoles (short VES)


Like SVES, ventricular extrasystoles signify additional potentials that invade normal heart rhythms. However, in contrast to the SVES, the potential here arises in ectopic (out-of-normal) excitation centers located in the ventricles.

Forms of ventricular extrasystoles

Frequent heart stumbling can be felt by those affected as disturbing.

One differentiates with the VES in:

  1. Monomorphic extrasystoles: ie every extrasystole is similarly deformed or simpler - all extrasystoles look exactly the same. Partially they occur in healthy people, sometimes in heart disease.
  2. Polymorphic extrasystoles: the extrasystoles are deformed differently, look different. This is always based on a heart muscle damage (poly = much, morph = shape)
    Polymorphic ES are usually also polytopic, ie they are of different origin (topos = location)

Although extrasystoles are potentials that intervene, so to speak, outside the normal rhythm, they often have a regular relationship to the normal rhythm. One differentiates here:

  1. Trigeminal or couplets: Here are two extrasystoles follow each normal potential, that pattern would be: N EE (compensatory pause) N EE.
  2. Salven: Following three or more extrasystoles consecutively, without a normal potential in between, it is called volleys. The pattern would be eg: N EEE (Kompenstorische Pause) NNN EEEEE. This is also referred to as non-persistent tachycardia.

Non-persistent tachycardia refers to a fast heart rate of over 100 beats per minute, but lasting less than 30 seconds. If the phase of the frequency increase exceeds 30 seconds, it is called a sustained tachycardia. Persistent ventricular tachycardias are life-threatening conditions that can result in ventricular fibrillation (in fact cardiac arrest). Therefore, non-persistent tachycardia should always be taken seriously.

A special feature is the "R-on-T-phenomenon". If an extrasystole falls into the rhythm at a very short distance to the previous normal potential, it may happen that the extrasystole connects to the descending leg of the T-wave. It is called the period in which the T-wave ends "vulnerable (vulnerable) phase", as in this phase by dangerous potential ventricular fibrillation (see below) can be triggered.

These distinctions are listed in the Lown classification. The degree of VES to Lown indicates the prognosis of the disease, but the classification has lost importance.

LOWN classification

Simple VES

  • Grade I: Monomorphic VES under 30 times per hour
  • Grade II: Monomorphic VES over 30 times per hour

Complex VES

  • Grade III: Polymorphic VES
  • Grade IVa: trigeminal / couplets
  • Grade IVb: salvos
  • Grade V: "R-on-T phenomenon"


As with SVES, ventricular extrasystoles often lack symptoms. In some cases, it can lead to the feeling of heart stumbling. Long-lasting trigeminal or salvo phases may cause the heart's stroke volume to fall. Since the pause, which lies between two normal potentials and in which the heart fills with blood, is shortened by the extrasystole, the volume that is expelled from the heart is reduced. This can lead to a short-term under-perfusion of the brain, which can lead to dizziness or even short syncope (fainting fits).
Read more about heart stumbling symptoms


The occurrence of ventricular extrasystoles is usually an expression of damage to individual cells of the heart muscle, they often point to a heart disease, eg CHD or heart failure (heart failure). They rarely occur in healthy people.
Read more about heart stumbling causes

Heart stumbling through alcohol

"Holiday Heart Syndrome" refers to acute cardiac arrhythmia, which can occur, for example, after a weekend or vacation with increased to excessive alcohol consumption. The reason why alcohol promotes cardiac arrhythmias and heart stuttering is not fully understood.

So far only one study has proven that there is a clear correlation. Which alcoholic beverages are worse and which are less harmful to health, was not determined. To explain the context, several theses have been prepared.

Experts suggest that alcohol stimulates the sympathetic nervous system - the activating system - and inhibits the parasympathetic nervous system - the relaxing system - that increases the heart rate and promotes cardiomyocyte damage. The dehydrating effect of alcohol (increased urination with alcohol consumption ) disturbs the electrolyte balance of our body and could also be a reason for arrhythmia of the heart tissue.

Under the influence of alcohol, the blood pressure increases - the development of high blood pressure ( hypertension ) and chronic heart failure is favored. These diseases are often triggers of heart stuttering or other cardiac arrhythmias. However, to a lesser extent, alcohol has a protective effect on the cardiovascular system, if one can believe studies that have dealt with the issue. However, responsible use of alcohol protects consumers from unwanted side effects and lasting damage.

Heart stumbling under stress

Under physical exertion, such as hard work or sport, the human organism is put into an activated state. It activates the sympathetic nervous system, part of the autonomic nervous system: the blood pressure increases, the pulse rate becomes faster, blood vessels narrow and the bronchi of the lungs expand to ensure greater breathing.

The body is preparing for a fight or flight through this stress response. This response is designed to protect people from a potentially dangerous situation and to ensure the optimal use of physical abilities. As a result of these changes but also unwanted breathing difficulties and dizziness, but also tachycardia and heart stumbling occur.

Especially in people with poor general condition or poor fitness, too much stress due to hard work or sport can lead to unpleasant symptoms.

Except when exposed to physical activity, the organism can be strained even in case of illness. Severe illnesses weaken the organism and sensitize the patient to their own body sensation. As a result, it can happen that sufferers increasingly perceive heart stumbling. In addition, inflammation of the heart or the pericardium may occur, which may also cause cardiac arrhythmias.

Heart stumbling through sports

Especially during sports heart stumbling may occur.

Extrasystoles during or after sport can have different reasons and are partly favored by sports. On the one hand, there is a relative lack of oxygen in the tissue during exercise due to the increased consumption. This can promote heart stumbling.

On the other hand, while you are active in sports, more and more is released by the sympathetic adrenaline. Adrenaline makes the heart beat faster and stronger. In addition, the arousal threshold that must be overcome to trigger a heartbeat is lowered. This reduced threshold thus simplifies another heartbeat, so that an extrasystole can occur more easily. Therefore, it may be that the heart beats too often for a short time and thus triggers a heart stumble. Furthermore, a lack of magnesium and potassium may be responsible for extrasystoles during or after exercise. This often helps taking a magnesium-potassium mixture. In many patients the extrasystoles disappear again.

If, however, other symptoms such as dizziness, fainting or unusually high pulse increases during sports should be recorded, should be clarified urgently by a doctor. Here, diagnostic means such as resting ECG, exercise ECG and cardiac ultrasound can provide information about the state of health of the heart.

Heart stumbling on a cold

The cold is a vaguely defined name for an infectious disease caused by viruses. These can be very different viruses. The course can be complicated by a bacterial infection, which may additionally occur. Especially the respiratory tract, especially the nasal mucous membranes, the throat or the bronchi, are affected by the common cold. Frequently, patients complain of pain in the throat and swallowing, an accompanying runny nose, which may be accompanied by a feeling of pressure in the head as well as headaches and body aches. In addition, feelings of weakness and exhaustion can occur. In some cases, fever also occurs.

During an infectious disease, the body is under an increased load. As a result, it may happen that extrasystoles can occur more frequently during an infectious disease, which can be perceived by the patient as heart stumbling. Frequently, sufferers have a heightened awareness of physical ailments during a cold and perceive occurring extrasystoles more often.

If, after the disease has healed, there are frequent cases of heart stumbling and breathing difficulties such as shortness of breath, there is the possibility that myocarditis is present and responsible for the symptoms.

Heart stumbling in stomach problems

Since the stomach and heart are very close together, they can influence each other. Discomfort to the stomach can also cause heart stumbling and other heart problems.

The diaphragm spatially separates the heart and stomach. If there is a diaphragmatic fracture, the stomach may slip up into the thorax and displace the heart. Most of all, this happens after meals. The repression affects the heart in the function and it can heart stumble, too fast pulse ( tachycardia ) or a tightness in the chest ( angina pectoris ) occur. This special form of diaphragmatic fracture and the resulting cardiac symptoms are also called Roemheld syndrome. Roemheld syndrome can be caused by excessive food, strong gas production by distensible food (eg cabbage) or lactose intolerance in addition to a diaphragmatic fracture.

In any case, to treat the syndrome, be careful not to eat foods that puff your stomach and intestines (whichever foods are intolerable) or overeat. If a diaphragmatic fracture is the cause, it may be necessary to think about surgery.

Heart stumbling through back problems

Back problems - especially in the area of ​​the cervical spine but also in the thoracic spine - can also trigger heart stuttering. This is because the nerves of the sympathetic (vegetative nervous system), which control the heartbeat, run close to the spine. If these are irritated or injured, they can be misdirected and, for example, trigger extra strikes and thus heart stumbling. If there are blockages in the area of ​​the thoracic spine, the chest can be narrowed. If the ribcage is not mobile, the heart may also suffer and be displaced or contracted. This irritation can then trigger the heart stumbling. Even if back problems or blockages in the spine were detected, a direct heart problem that could cause the heart stumble should be excluded by the doctor.

Heart stumbling while lying down

People who are affected by heart stumbling, report that the heart stumbling is dependent on their location and position. It can occur depending on the position and also disappear again. In these persons, the heart stumbling occurs, especially when lying down, but there are also activities such as bending over or rapid change in position called.

The situation on the left side is particularly frequently mentioned, which, according to those affected, leads to perceptible heart stumbling, which can also disappear again after repositioning.

Causes for the fact that the heart stumbling is position-dependent and can occur particularly when lying, can often not exactly be limited.
Possible explanations for position-dependent cardiac stumbling could provide the spine. Between the 2nd cervical vertebra and the 4th thoracic vertebra nerve fibers arise, which can influence the activity of the heart. In spinal problems between these vertebrae, but especially between the 2nd and 4th thoracic vertebrae, functional cardiac discomfort, such as intermittent cardiac arrhythmia, which may be associated with cardiac arrest, is relatively common.

If a heart stumbling while lying is perceived again and again, the heart should be examined in any case. In most cases, however, they are harmless extra beats that can happen to every human every now and then.

More information can be found under: Heart stumbling while lying down

Heart stumbling through stress

Severe stress can promote the occurrence of heart stuttering.

Another major and common cause of heart stumbling can be stress. This is based on the physical stress response with which humans react to high psychological and physical stress. During a stress reaction, the autonomic nervous system is activated - the system that unconsciously controls body reactions. It is characterized by the sympathetic and parasympathetic nervous system. If the body is in stress, the sympathetic nervous system is active. Increased levels of adrenaline and other stress hormones are being released. Adrenaline not only makes the heart beat stronger and faster, it also makes it easier to respond to stress hormones, making it easier to trigger another heartbeat. This can ultimately lead to extra beats. These are then perceived as heart stumbling. Heart stumbling is not always associated with stress or even with every person and can sometimes occur in healthy people. Therefore, a heart stumble from time to time is completely normal. However, should the heart stumble persist for a long time, the stress should be reduced and a doctor should be consulted to rule out an organic cause.

The function of stress hormones is basically to adapt the body to increased stress and provide stored energy reserves to prepare the person for a fight or flight (" fight or flight "). They affect various organs of our body, including the heart.

The digestion and salivation are inhibited, the bronchi of the lungs are widened to facilitate breathing under high stress and the blood vessels are narrowed.
At the heart it comes to increased blood pressure and accelerated heartbeat.

In this context, difficulty breathing, dizziness, palpitations and heart stumbling may occur. Studies have shown that high levels of adrenaline in the blood can promote the appearance of extrasystoles and the associated cardiac arrest.

In addition, physical and psychological stress can affect sleep patterns and recovery. People who are under stress may also suffer from sleep disorders or sleep deprivation and fatigue.

Mental stress factors can be, for example, the workplace, great responsibility, conflicts with the partner or the social environment, serious events, such as the death of a relative, or financial problems, and can be perceived as very stressful.

Even physical stress such as a serious illness or other stressful situations can trigger a stress response.

In particularly stressful phases, it can help to actively relax in order to avoid damage to the body and be able to handle the stress better. More about this topic can be found at : Relaxation

These factors have also been shown to be associated with cardiac arrest and may promote the onset of cardiac arrest. The high consumption of coffee and the caffeine that often occurs during stress can also promote the occurrence of heart stuttering. In the long term, lasting stress can be detrimental to the heart. In addition to the heart stumble it comes in the long term to a chronically elevated blood pressure and deposits in the vessels, the so-called arteriosclerosis. This in turn increases the risk of dangerous sequelae, such as heart attack or stroke, which can be fatal in the worst case scenario.

Heart stumbling through medication

Heart stumbling can also be caused by medications that affect the heart.

These include various medications such as digoxin, a rarely prescribed medication for chronic heart failure, the so-called tricyclic antidepressants, or even drugs such as cocaine.

Which drug is responsible for the heart stumbling, you should always have a doctor clarify and not stop by itself to take the medication.

Also heart muscle inflammation, damage to the heart valves and other heart diseases can cause heart stumbling, as well as magnesium and potassium deficiency.

Heart stumbling during menopause

Menopause is the time when a woman goes from a mature state to a hormonal state of rest and loses her fertility. This leads to strong hormonal changes that show direct effects on the woman's body. Since many women have always been healthy before, new symptoms are often shocking and disturbing.

Cardiac arrhythmia is one of a number of symptoms that are characteristic of the conversion phase, such as hot flashes, sleep disorders and irritability. Often, mood swings due to hormone reduction mate with heart stumbling and can trigger anxiety and panic attacks. These heart complaints can also be felt as palpitations, palpitations or Herzbeklemmung. Due to the steadily decreasing estrogen levels, which is caused by the reduced production by the ovaries, there is an unfamiliar estrogen deficiency. This hormone deficiency mainly affects the autonomic nervous system. Since this controls the heartbeat, occasionally an extra impact can occur, which is perceived as heart stumbling.

Since in rare cases, organic damage to the heart can cause tripping, a doctor should be consulted. He can then check whether the heart stumbling is actually caused by the menopause complaints or another cause underlying the heart stumbling.

For the treatment of (post) menopausal complaints mainly natural remedies are administered to keep the burden on the body as low as possible. Hormone replacement therapy is recommended only for severe symptoms and requires medical supervision.

Heart stumbling in the night

As already mentioned, heart stumbling occasionally occurs in healthy individuals and is therefore not always the proof of a pathological process. Above all, a person perceives an extra impact of the heart rather in peace than in everyday life, when he is in motion and distracted. Therefore, it is easier to register a heart stumbling at night than during the day.

During periods of stress, the stuttering of the heart may be triggered at night by the autonomic nervous system, which is more sensitive at such times. However, if the heart stumbling lasts longer at night (several minutes to hours) or if other symptoms are added, such as respiratory distress, a doctor should be consulted. This can exclude by appropriate means (heart ultrasound, stress ECG and long-term ECG) that it concerns a serious and treatment requiring heart defect.


The diagnosis of ventricular extrasystoles is made using long-term and exercise ECG. Since VES can be the first expression of heart disease, a careful clinical examination follows.

In ECG, ventricular extrasystoles are recognized as QRS complexes that are too early to beat and may be slightly widened. You are not preceded by a P-wave. After the premature QRS complex follows a compensatory pause (in contrast to the SVES). The clock of the sinus node is not affected in a VES, the additional electrical potentials come from the chamber muscles. The transfer of the sinus node potentials to the chamber is not possible after a ventricular extrasytole, since the just-excited chamber muscles are not yet ready for the next stimulus - it is said to be refractory. There is a break. Only at the next sinus node potential is again a chamber excitation.


In case of frequent heart stumbling, a doctor should always be consulted.

VES in healthy people usually need no therapy. If the ventricular extrasystoles are based on diseases of the heart, they are primarily treated. They are most important for the prognosis. In addition, the amount of salts potassium and magnesium in the blood should be kept highly normal.

If the therapy for the underlying disease is not sufficient to stabilize the condition, it is necessary to resort to a specific anti-arrhythmic therapy if the extrasystoles are symptomatic or have to be regarded as so-called "warning arrhythmias", which are the forerunners of threatening ventricular tachycardia. This is the case from Level Ivb of the LOWN classification. In most of these cases, class III antiarrhythmics (amidarone, soltalol) are used. Class I antiarrhythmic drugs may only be used in patients without heart disease.
Read more about heart stumbling therapy

Homeopathy for heart stumbling

Even heart stumbling can be treated well by homeopathy. However, it must be ruled out that there is heart disease.
For this we have published an independent topic:

  • Homeopathy for heart stumbling


In healthy people, the ventricular extrasystoles have a good prognosis. In heart disease, they are risk factors for sudden cardiac death and, depending on the LOWN classification, may also be considered as warning arrhythmias for ventricular fibrillation.

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