Functional heart problems - when the heart beats without being ill

How physiotherapy and occupational therapy can help with heart symptoms without an organic cause

A stumbling in the chest, a sudden rapid heartbeat, a feeling of tightness - and yet the ECG shows that everything is fine. Functional heart complaints are among the most common physical symptoms without a clear organic cause. For those affected, this is often difficult to understand - and even more difficult to bear.

Despite inconspicuous findings, they experience heart stumbles (extrasystoles), tachycardia, pressure on the chest or shortness of breath. The symptoms are real - even if they are not caused by heart disease. In many cases, the cause is not in the heart muscle, but in the nervous system.

What are functional heart problems?

Functional heart complaints (also known as somatoform cardiac complaints) are symptoms such as

• Palpitations (tachycardia)

• Heart stumbling (extrasystoles)

• Feeling of pressure or tightness in the chest

• Shortness of breath or the feeling of "not being able to breathe"

• Dizziness, trembling, restlessness

...without the presence of structural heart disease. In most cases, the symptoms cannot be explained during a cardiological check-up. The cause often lies in the interaction of:

• autonomic nervous system (sympathetic/parasympathetic nervous system),

• emotional stress,

• Body awareness and

• psychosomatic stress.

Why the heart (apparently) goes crazy

The heart is strongly controlled by the autonomic nervous system - in particular by the vagus nerve. In the event of constant stress, chronic tension, lack of sleep or emotional stress, the system becomes unbalanced. The result:

• The sympathetic nervous system (stress nerve) becomes overactive → heart rate increases

• The parasympathetic nervous system (calming nerve) loses its effect → Heart rhythm becomes more irregular

• Body awareness is hyperactivated → every small change is interpreted as "threatening"

The brain reads body signals through the lens of fear - and the heart reacts promptly.

The body remembers - functional complaints as an expression of inner tensions

Functional heart problems often arise in the context of:

• Chronic stress, excessive demands, internal pressure

• Panic attacks and anxiety disorders

• post-traumatic stress disorder (PTSD)

• emotional high sensitivity

• Exhaustion (burnout, ME/CFS, long Covid)

The body becomes an organ of expression of inner states. And the heart - as a symbol of vulnerability, closeness and vitality - is often particularly receptive.

Therapy: What physiotherapy and occupational therapy can achieve

Even if there is no organic disease, the therapy can have a great effect. The aim is to calm the nervous system, normalize body perception and regain security in one's own experience.

Physiotherapeutic approaches

• Respiratory therapy & vagus activation:

  • Slow exhalation (4-6 breaths/min), breathing anchor in case of panic, sense breathing spaces

  • Combining breath + movement (medical yoga, active mobilization)

• Tone regulation & vegetative balance:

  • Relaxation exercises (PMR, fascia release), warmth, body contact

• Heart rate-oriented movement training:

  • Gentle endurance training in the area below the stimulus threshold

  • HRV training with biofeedback (e.g. Oura, Whoop, Polar)

• Pacing and energy management:

  • Dosed load build-up, exercise without excessive demands

🟡 Occupational therapy perspective

• Stress analysis & everyday structure:

  • How much excitement, performance and stimulation is there in the day?

• Pacing in everyday life & work:

  • Mini-breaks, rhythmization, stimulus reduction (e.g. noise, light, social interaction)

• Strengthen self-efficacy:

  • Experience movement as a calming force

  • Breathing and physical exercises as an "emergency kit" for symptoms

• Dealing with fear of symptoms:

  • Educational, validating, slow via exposure

The heart wants to be heard - not just measured

A functionally reacting heart needs understanding - not just medical control. For many sufferers, it is a relief to learn that the symptoms are real, but not dangerous. In therapy, the focus is not on finding a "cure", but on building up physical safety, vegetative stability and emotional self-regulation.

Conclusion: The heart beats for you - not against you

Functional heart complaints are an expression of a stressed inner world. They do not arise from weakness, but from an overstretched system. Physiotherapy and occupational therapy can help you to get to know your own heart anew - not as a place of fear, but as a trustworthy pacemaker of life.

👉 Are you a therapist and want to learn more about functional complaints, autonomic regulation and body-oriented strategies?

Then discover our training courses on pain physiology, medical yoga and body-centered therapy at:
🌐 www.hockenholz.com/weiterbildungen