Extrasystoles (palpitations)

Synonyms in the broadest sense

Extra heartbeat, palpitations, ventricular extrasystoles, supraventricular extrasystoles, palpitations, palpitation


One calls one an extrasystole Heartbeatthat falls outside of the normal heart rate in the normal rhythm.Extrasystoles are very common, even in healthy people. Mostly extrasystoles go unnoticed or they express themselves as "Heart stumbling or skipping". According to the place of origin of the extrasystole, a distinction is made between:

  1. Supraventricular Extrasystole and
  2. Ventricular Extrasystole

1. Supraventricular extrasystoles (SVES for short)

Individual supraventricular extrasystoles interspersed in the basic sinus rhythm (Extra blows from the forecourt) are common and usually a harmless incidental finding. The cells that generate the potential that “dances out of line” are in the atrium. They do not belong to the normal stimulation system such as the sinus node. They are called ectopic excitation centers.


Cardiac stumbling belongs to the group of cardiac arrhythmias.

There can be several underlying causes for palpitations. It is caused by abnormal ventricular activity (Ventricle), which outside of the normal heart rate to an additional ("extra") Heartbeat leads (so-called extrasystole).

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

Find out more about: Tension in the chest

Cardiac stumbling, which is caused by a supraventricular extrasystole, is common among those affected not noticed at all and does not necessarily mean that there is a heart disease, because also with They can appear completely healthy.

People who are anxious about the extra heartbeats may have Sweats, nervous restlessness and increased heart rate react.

On the other hand, cardiac stumbling, which is generated by ventricular extrasystoles, is clearly perceived by those affected. Here it can be related to the palpitations clearly palpable and above all irregular heartbeat come. The extra heartbeats can also be called particularly strong be felt. Also the feeling of a "skipped heartbeat“Can arise.
A side effect can also be a Feeling short of breath occur. Affected people also report Dizziness and Drowsiness and may feel tired and powerless, especially after greater exertion such as after exercise.

Also Chest pain or a Feeling anxious can be a side effect. Here, too, people who react sensitively to the additional, clearly noticeable heartbeats can be Anxiety then develop in turn with complaints such as Sweats, nervous restlessness and Tremble can be connected. A following Panic attack can get up to Mortal fear develop and a Faint (syncope) trigger. The psyche plays a bigger role on the body than the effect of the extrasystole itself.

Supraventricular extrasystoles usually produce no symptoms. It rarely happens Palpitations or Palpitations.


As already described, extrasystoles can occur without any disease value. Usually they are caused by excitement or e.g. triggered by stimulants such as coffee, alcohol or nicotine. However, extrasystole can also be an indication of heart disease. Sick heart cells tend to generate false potentials. Is there a heart disease such as a coronary heart disease (coronary artery disease), an inflammation of the myocardium or a heart attack, extrasystoles can also trigger dangerous persistent arrhythmias at the atrial and ventricular levels, e.g. a persistently fast heartbeat (tachycardia; see below).

Metabolic disorders such as an overactive thyroid can also lead to extrasystoles.

Read more on the topic Heart stumbling causes and these symptoms can be used to recognize a magnesium deficiency


Long-term and stress ECGs are used to diagnose supraventricular extrasystoles. The origin of the extrasystoles can only be clarified by an EKG. The long-term ECG can show whether sustained tachycardias are occurring in addition to individual extra-stasis. Usually the patient is asked to record during the long-term ECG when he feels symptoms. In this way it can be determined whether the symptoms and the extrasystoles occur at the same time and thus a causal relationship can be assumed or whether further causes of the symptoms must be searched for. The exercise ECG can be used to determine whether the extrasystoles occur more frequently during physical exertion.

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

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

In the ECG, extrasystoles can usually be recognized as narrow (i.e. normally shaped) QRS complexes that occur earlier in the cycle. The preceding P-wave can be larger than a normal P-wave. With a supraventricular extrasystole, a so-called non-compensatory pause occurs after the additional QRS complex, i.e. the beat of the sinus rhythm is shifted.

Please also read: Extrasystoles in the ECG in the case of myocarditis


Supraventricular extrasystoles, which occur in healthy people, do not require therapy. In the presence of a heart disease, the therapy of this disease is the first priority. If the SVES trigger tachycardia or other cardiac arrhythmias, treatment is definitely required. Usually beta blockers or potassium-magnesium preparations are used for this.
Read more on the subject Palpable Heart Therapy

2. Ventricular extrasystoles (VES for short)


Just like SVES, ventricular extrasystoles denote additional potentials that occur in the normal heart rhythm. In contrast to the SVES, however, the potential here arises in ectopic (outside of the normal areas) excitation centers that are located in the heart chambers.

Forms of ventricular extrasystoles

Frequent palpitations can be perceived as annoying by those affected.

A distinction is made between the VES in:

  1. Monomorphic extrasystoles: i.e. every extrasystole is deformed in the same way or more simply - all extrasystoles look exactly the same. Sometimes they occur in healthy people, sometimes in heart disease.
  2. Polymorphic extrasystoles: the extrasystoles are deformed differently and look different. Here is always a heart muscle damage (poly = much, morph = shape)
    Polymorphic ES are mostly also polytopic, i.e. they are of different origin (topos = place)

Although extrasystoles are potentials that play outside of the normal rhythm, so to speak, in between, they often have a regular relationship to the normal rhythm. A distinction is made here:

  1. Trigeminal nerve or. Couplets: Here, each normal potential is followed by two extrasystoles that would be the pattern: N EE (compensatory pause) N EE.
  2. Volleys: Follow three or more extrasystoles in a row, Without a normal potential in between, one speaks of volleys. The pattern would be for example: N EEE (compensatory pause) N N N EEEEE. One speaks here of non-persistent tachycardias.

Non-persistent Tachycardia denote a fast Heart rate of over 100 beats per minute, which lasts less than 30 seconds. If the phase of the frequency increase lasts more than 30 seconds, one speaks of persistent tachycardia. Persistent ventricular tachycardias are life-threatening conditions that result in ventricular fibrillation (de facto Cardiac arrest) can end. Therefore, non-persistent tachycardias should always be taken seriously.

This is a specialty "R-on-T phenomenon" If an extrasystole falls in a very short distance from the previous normal potential, it can happen that the extrasystole connects with the descending limb of the T-wave. The period in which the T-wave ends is also called the “vulnerable phase”, since in this phase dangerous ventricular fibrillation (see below) can be triggered by incident potentials.

These distinctions are in the classification according to Lown compiled. The degree of VES according to Lown provides information on the prognosis of the diseases, but the classification has lost its importance.

LOWN classification

Simple VES

  • Grade I: Monomorphic PVCs less than 30 times per hour
  • Grade II: Monomorphic PVCs over 30 times per hour

Complex VES

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


As with SVES, symptoms are often absent with ventricular extrasystoles. In some cases, you may experience a palpitations. Long-lasting trigeminal or volley phases can lead to a decrease in the stroke volume of the Heart come. 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 ejected by the heart is reduced. This can result in a short-term reduced blood flow to the brain, which leads to dizziness or even brief syncope (fainting).
Read more on the topic Palpitations Symptoms


The occurrence of ventricular extrasystoles is usually an expression of damage to individual cells of the heart muscle, so they often indicate a heart disease, e.g. CHD or Heart failure (Heart failure). They rarely occur in people with healthy hearts.
Read more on the topic Palpitations causes

Palpitations from alcohol

The “holiday heart” syndrome is the term used to describe acute cardiac arrhythmias, which can occur, for example, after a weekend or vacation with increased or excessive alcohol consumption. The reason why alcohol promotes cardiac arrhythmias and heart palpitations is not exactly understood.

So far, only one study has shown that there is a clear connection. It was not determined which alcoholic beverages are worse and which are less harmful to health. Several theses were put forward to explain the connection.

Experts suspect that alcohol affects the sympathetic the activating system - stimulates and the parasympathetic nervous system - the relaxing system - inhibits, thus increasing the pulse and promoting damage to heart muscle cells. The dehydrating effects of alcohol (Increased urination with alcohol consumption) disrupts the electrolyte balance in our body and could also be the reason for arrhythmias in 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 the cause of heart stumbling or other cardiac arrhythmias. To a small extent, however, alcohol also has a protective effect on the cardiovascular system, if one can believe studies that have dealt with the topic. However, responsible use of alcohol protects consumers from undesirable side effects and permanent damage.

Heart stumbling during exercise

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

The body prepares itself for a fight or flight ("fight or flight") through this stress reaction. This reaction is intended to protect people from a potentially dangerous situation and to ensure optimal use of physical abilities. As a result of these changes, however, unwanted breathing difficulties and dizziness, but also palpitations and heart palpitations can occur.

Excessive exposure to hard work or sport can lead to unpleasant symptoms, especially in people with a poor general condition or poor fitness.

In addition to being stressed by physical activity, the organism can also be stressed by illness. Serious illnesses weaken the organism and sensitize the patient to their own body. This can lead to the fact that sufferers are more aware of heart palpitations. In addition, it can lead to inflammation of the heart or the pericardium, which can also cause irregular heartbeat.

Find out more about the topic here: The stumbling of the heart during exertion.

Palpitations from exercise

Heart palpitations can occur especially during exercise.

Extrasystoles during or after exercise can have various reasons and are sometimes promoted by exercise. On the one hand, there is a relative increase in consumption during exercise due to the increased consumption Lack of oxygen in the tissue. This can promote heart stumbling.

On the other hand, while one is active in sports, it increases through the sympathetic nervous system adrenaline poured out. Adrenaline makes the heart beat faster and stronger. In addition, the Excitation thresholdthat must be overcome to trigger a heartbeat, degraded. This lowered threshold therefore simplifies another heartbeat, so that an extrasystole can occur more easily. It is therefore possible that the heart beats too often for a short time and this triggers a palpitations. Furthermore, a Deficiency in magnesium and potassium be responsible for extrasystoles during or after exercise. Taking a magnesium-potassium mixture often helps. In many patients the extrasystoles then disappear again.

But should other symptoms such as dizziness, Fainting or unusually high Pulse rises be recorded during sport, a doctor should urgently clarify it. Diagnostic means such as resting ECG, stress ECG and cardiac ultrasound can provide information about the state of health of the heart.

Palpitations with a cold

In the cold it is a vaguely defined term for an infectious disease caused by Viruses caused. These viruses can be very different. The course can be through a bacterial infectionthat can additionally complicate matters. The respiratory tract is particularly affected by the common cold, especially the ones Nasal mucous membranes, neck or the Bronchi. Often patients complain Pain in the throat and when swallowing, an accompanying sniffwhich can be accompanied by a feeling of pressure in the head as well as over Headache and body aches. In addition, feelings of weakness and exhaustion can occur. In some cases it also occurs fever on.

During an infectious disease, the body is therefore under increased stress. As a result, it can happen that during an infectious disease more often Extrasystoles can occur, which the sick person can perceive as a heart stumble. Often, people who have a cold also have one increased awareness of physical ailments and perceive extrasystoles occurring more frequently.

After the disease has healed, palpitations and breathing difficulties such as shortness of breath on, there is a possibility that a Myocarditis is present and is responsible for the symptoms.

Stumbling of the heart with stomach problems

Since the stomach and heart are very close together, they can also affect each other. Discomfort in the stomach can also trigger palpitations and other heart problems.

The diaphragm spatially separates the heart and the stomach. When a Diaphragmatic hernia the stomach can slide up into the chest and that Displace heart. Most of all, this happens after meals. The function of the heart is influenced by the displacement and heart stumbling can occur too fast pulse (Tachycardia) or a Chest tightness (Angina pectoris) occur. This special form of the diaphragmatic hernia and the cardiac symptoms triggered by it are also called Roemheld Syndrome. In addition to a diaphragmatic hernia, Roemheld syndrome can also be caused by overeating, excessive gas production from flatulent food (e.g. cabbage) or lactose intolerance.

To treat the syndrome, one should definitely make sure not to eat foods that bloat the stomach and intestines (depending on which foods are not tolerated) or not overeat. If a diaphragmatic hernia is the cause, surgery may need to be considered.

Heart stumbling due to back problems

Back problems - especially in the area of Cervical spine but also in the Thoracic spine - can also trigger heart palpitations. That's because the Sympathetic nerves (vegetative nervous system), which control the heartbeat, run close to the spine. If these are irritated or injured, they can be misdirected and trigger, for example, extra beats and thus palpitations. It occurs in the thoracic spine area Blockages, the chest can become narrowed. If the rib cage is immobile, the heart can suffer and become crowded or narrowed. This irritation can then trigger the palpitations. Even if back problems or blockages in the spine were detected, a direct heart problem that could cause the heart to stumble should be ruled out by the doctor.

Palpitations while lying down

People who are affected by heart stumbling report that they have heart stumbling depending on the location and position is. It can appear and disappear again depending on the situation. In these people, the stumbling of the heart occurs mainly when lying down, but activities such as themselves bend over or rapid change of position called.

The Location on the left listed, according to the statements of those affected noticeable palpitations which can disappear again after repositioning.

Reasons for the stumbling of the heart to occur depending on the position and especially when lying down can often not be precisely delimited.
Possible Attempts to explain for positional cardiac stumbling could the Spine deliver. It spring between that 2. cervical vertebrae and the 4. Thoracic vertebrae Nerve fibers that can affect the activity of the heart. With spinal problems between these vertebrae, but especially between the 2nd and 4th thoracic vertebrae, it is relatively common functional heart problems observed, for example intermittent ones Cardiac arrhythmiasthat can be associated with palpitations.

When a heart palpitations while lying down again and again perceived, the heart should definitely examined become. In most cases, however, these are harmless extra blows that can occur to everyone from time to time.

You can find more information at: Palpitations while lying down

Palpitations from stress

Severe stress can make heart palpitations more likely.

Another significant and common cause of palpitations can be stress be. This is based on physical stress responsewith which the human being on high mental and physical stress responds. 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 nerves. If the body is under stress, that is Sympathetic active. It will be increased adrenaline and other stress hormones released. Adrenaline not only ensures that the heart beats stronger and faster, but also that it reacts more easily to stress hormones and thus a new heartbeat can be triggered more easily. Ultimately, this can lead to Extra blows arise. These are then perceived as palpitations. The palpitations do not always occur with stress and also not in every person and can sometimes also occur in healthy people. Hence a Heart palpitations now and then completely normal. However, if the palpitations persist for a long time, the stress should be reduced and a doctor should be consulted who can rule out an organic cause.

The function of the stress hormones is basically that Adaptation of the body to increased stress and a Provision of stored energy reservesto get people on a fight or an escape ("fight or flight"). They influence the most varied of organs in our body, including the heart.

The digestion and the salivation inhibited that The bronchi of the lungs are dilated to facilitate breathing under high stress and the Blood vessels narrowed.
It comes to the heart increased blood pressure and accelerated heartbeat.

In this context you can Difficulty breathing, dizziness, racing heart and also Palpitations occur. Research has shown that high levels of adrenaline in the blood can promote the occurrence of extrasystoles and the associated palpitations.

Furthermore, physical and psychological stress can have an impact on sleep behavior and recovery. People who are under stress may also suffer from it sleep disorders or sleep deprivation and States of exhaustion.

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

Also physical loads such as one major 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 to be able to deal with the stress better. More about this topic can be found: Relaxation

It has been shown that these factors are also related to heart stumbling and can promote the occurrence of heart stumbling. Also the high consumption of Coffee and the caffeine it contains can promote the occurrence of palpitations. In the long term, prolonged exposure to stress can be harmful to the heart. In addition to the palpitations, it comes to a long-term chronically high blood pressure and deposits in the vessels, the so-called arteriosclerosis. This in turn increases the risk of dangerous secondary diseases like that Heart attack or strokewhich in the worst case can be fatal.

Read a lot more information on our site: Palpitations from stress

Palpitations from medication

Palpitations can also be caused by drugs that affect the heart.

These include various drugs such as Digoxin, a rarely prescribed drug for chronic heart failure, the so-called tricyclic Antidepressants, or drugs like cocaine.

A doctor should always clarify which medication is responsible for the palpitations and you should not stop taking the medication yourself.

Also one Myocarditis, Damage to the heart valves and other heart diseases can be causes of palpitations, as well as magnesium- and Potassium deficiency.

Palpitations during menopause

As menopause (menopause) is the time in which a woman passes from a sexually mature state to a hormonal dormancy and loses her fertility. This leads to major hormonal changes that have a direct effect on the woman's body. Since many women have always been healthy before, the new symptoms that appear are often shocking and worrying.

Read more about this on the main page: Palpitations during menopause

A number of symptoms that are characteristic of the transition phase, such as hot flashes, sleep disorders and irritability, include cardiac arrhythmias. The fluctuating mood caused by the hormone reduction is often paired with palpitations and can trigger anxiety and panic attacks. These heart problems can also make themselves felt as a racing heart, palpable palpitations or an oppression of the heart. The steadily falling estrogen level, which is caused by the reduced production by the ovaries, leads to an unusual lack of estrogen. This hormone deficiency mainly affects the autonomic nervous system. Since this controls the heartbeat, an extra beat can occur every now and then, which is perceived as a palpitation.

Since in rare cases organic damage to the heart can cause stumbling, a doctor should be consulted. This can then check whether the stumbling heart is actually a symptom caused by menopause or whether there is another cause of the stumbling heart.

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

Palpitations at night

As already mentioned, heart stumbling occurs from time to time even in healthy people and is therefore not always proof of a pathological process. Above all, people are more likely to take an extra beat of the heart in peace true than in everyday life, when he is in motion and distracted. Therefore, it is easier to register a palpitations at night than during the day.

While stressful phases The heart stumbling at night can be triggered by the autonomic nervous system, which reacts more sensitively at such times. Should the palpitations at night, however last longer (several minutes to hours) or other symptoms such as shortness of breath, a doctor should be consulted. Using suitable means (cardiac ultrasound, stress ECG and long-term ECG), this can rule out that it is a serious heart defect that requires treatment.


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

In the ECG, ventricular extrasystoles can be seen as QRS complexes that fall too early in the cycle and that can be slightly widened. They are not preceded by a P wave. The premature QRS complex is followed by a compensatory pause (in contrast to the SVES). The cycle of the sinus node is not affected in a PVC, the additional electrical potentials come from the ventricular muscles. However, the transfer of the sinus node potentials to the ventricle is not possible after a ventricular extrastasy, since the ventricular muscles that have just been excited are not yet ready for the next stimulus - they are said to be still refractory. There is a pause. Chamber excitation does not occur again until the next sinus node potential.


If you have frequent heart palpitations, you should always consult a doctor.

VES in healthy people usually do not require any therapy. If the ventricular extrasystoles are caused by diseases of the heart, these are given priority. They are most important for the prognosis. In addition, the amount of salts potassium and magnesium in the blood are kept high.

If the therapy of the underlying disease is not sufficient to stabilize the condition, specific antiarrhythmic therapy must be resorted to if the extrasystoles lead to symptoms or must be viewed as so-called "warning arrhythmias" that are regarded as harbingers of impending ventricular tachycardias. This is the case from level Ivb of the LOWN classification. Class III antiarrhythmics (Amidaron, Soltalol) are usually used in these cases. Class I antiarrhythmics may only be used here in patients without heart disease.
Read more on the topic Palpable Heart Therapy

Homeopathy for palpitations

Also Palpitations can be treated well by homeopathy. However, it must be ruled out that there is a heart disease.
We have published a separate topic for this purpose:

  • Homeopathy for palpitations


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