Is It Normal for the Stomach to Beat Like a Heart?

The rhythmic pulse sensation you occasionally feel in your abdomen, often described as “my stomach is beating like a heart,” can cause concern for many people. However, this feeling is usually nothing to worry about and most often results from sensing the normal pulsation of your abdominal aorta, the main artery running through your abdomen. Just as you can feel your pulse in your wrist, it’s possible to feel the beat of this large vessel. This sensation may be more noticeable, especially in thin individuals or in certain positions, and is generally considered physiological, meaning normal. However, if the sensation is persistent or bothersome, it may be helpful to consult a doctor just in case.

Is the Stomach Beating Like a Heart Always a Problem?

No, most of the time this sensation is completely normal and harmless. If you are under 50 years old, have no known risk of cardiovascular disease, and your overall health is good, there’s no need to worry. This can even be a sign that your body is functioning healthily. Feeling the strong pulsation of the largest artery in our body is a physiological occurrence.

However, in rare cases, this sensation may indicate a serious underlying condition called Abdominal Aortic Aneurysm (AAA). AAA is a weakening and ballooning of the wall of the aorta in the abdominal region. Therefore, it is important to clarify the source of the sensation.

In What Situations Is the Heartbeat-Like Sensation in the Stomach More Noticeable?

In some cases, this normal pulse sensation can become more noticeable.

• While lying down: When you lie on your back, especially if you gently pull your knees toward your abdomen, your abdominal muscles relax. In this position, the aorta may be closer to the abdominal wall, making the pulse easier to feel. In thin individuals, this pulsation may even be visible from the outside.
• After eating: After meals, the digestive system becomes more active. The body pumps more blood to the stomach and intestines. Increased blood flow through the aorta can make the pulse more strongly felt.
• During pregnancy: During pregnancy, blood volume increases. As the heart pumps more blood, the aortic pulse can become more pronounced. This is the mother’s own pulse, not the baby’s.
• Being thin: In people with little fat tissue in the abdominal region, the distance between the aorta and the skin surface is less. This makes the pulse easier to feel.

These situations explain why the sensation becomes more prominent and are generally not a cause for concern.

When Can the Heartbeat-Like Sensation in the Stomach Be a Symptom of an Abdominal Aortic Aneurysm (AAA)?

A pulse sensation felt in the abdomen can, in some cases, indicate a serious issue known as Abdominal Aortic Aneurysm (AAA). AAA is an abnormal expansion or ballooning of the aorta in the abdominal area. An aneurysm is defined when the vessel’s diameter increases to 1.5 times normal or exceeds 3 cm.

This pulse sensation should raise more suspicion in individuals with certain risk factors. Advanced age, male gender, smoking, and a family history of aneurysm are among the leading risk factors. If you have one or more of these risk factors and feel a pulse in your abdomen, it is important to consult a doctor.

Are There Other Symptoms of AAA Besides the Stomach Beating Like a Heart?

Yes, although AAA often progresses insidiously, it may give other symptoms as it grows or approaches rupture. In addition to the pulse sensation, deep, constant, gnawing or throbbing pain in the abdomen, back, or sides is the most common symptom. This pain usually does not change much with position.

More rarely, if the aneurysm presses on surrounding organs, you may experience abdominal fullness, early satiety, or weight loss. If clots within the aneurysm break off and travel to the legs, sudden coldness or discoloration in the feet may occur. However, remember that most AAAs do not cause any symptoms until they rupture, which is why they are also called “silent killers.”

What Happens If AAA Ruptures in the Case of the Heartbeat-Like Sensation in the Stomach?

Unfortunately, this is the most feared scenario and a life-threatening situation requiring urgent medical intervention. When the aneurysm wall ruptures, uncontrolled and severe internal bleeding from the aorta into the abdominal cavity begins.

This situation usually presents with the following symptoms: sudden, very severe, tearing pain in the abdomen or back. This is accompanied by rapidly developing low blood pressure, rapid heartbeat, dizziness, cold sweats, and even loss of consciousness. The mortality rate of ruptured AAA is very high; a significant proportion of patients die before reaching the hospital. For this reason, at the slightest suspicion, 112 (emergency services) should be called immediately.

What Are the Main Risks for AAA Related to the Heartbeat-Like Sensation in the Stomach?

There are several factors that significantly increase the risk of developing AAA. It’s important to be aware of these.

• Smoking: This is the most important risk factor. Chemicals in cigarette smoke weaken the aortic wall. The longer and more you smoke, the higher the risk. Quitting smoking reduces the risk.
• Age: Risk increases with age, especially after age 65.
• Gender: It is much more common in men than women.
• Family history: Having a first-degree relative (mother, father, sibling) with AAA increases the risk. There is a genetic predisposition.

These main risk factors show who should be more vigilant regarding AAA.

Are There Other AAA Risk Factors to Consider in the Case of the Heartbeat-Like Sensation in the Stomach?

Yes, in addition to the main risk factors, there are other conditions that may influence the likelihood of developing AAA.

• Atherosclerosis (Arterial Hardening): The accumulation of fat and calcium (plaque formation) in the vessel walls weakens the vessel and prepares the ground for aneurysm development. This is the most common underlying cause.
• High Blood Pressure (Hypertension): Uncontrolled high blood pressure constantly strains the aortic wall, wearing it down.
• Other factors: High cholesterol, vascular disease elsewhere in the body (such as blockage in leg arteries), certain genetic connective tissue disorders (such as Marfan Syndrome), vascular inflammation, or rarely infections can also increase risk.

Having more than one risk factor increases the risk even further. For example, an elderly man who smokes and also has a family history of aneurysm has a particularly high risk.

How Is a Doctor’s Examination for the Heartbeat-Like Sensation in the Stomach Performed?

When you see a doctor with this complaint, the doctor will first talk with you in detail. They will ask about your symptoms, how long they have been going on, and whether there are any other accompanying complaints. They will want to know about risk factors such as smoking and family history, as well as your general health status.

Then, a physical examination will be performed. The doctor may listen to your abdomen to check for any abnormal vascular sounds (bruits). They may also palpate your abdomen, especially around the navel, to feel for a pulsatile mass (enlarged aorta). However, a physical exam alone may not be sufficient for diagnosis, especially in overweight individuals or if the aneurysm is small.

What Imaging Tests Are Done If AAA Is Suspected in the Case of the Heartbeat-Like Sensation in the Stomach?

If physical exam findings or your risk factors suggest AAA, your doctor will order imaging tests to confirm or rule out the diagnosis.

• Abdominal Ultrasonography (USG): This is usually the first-choice test. It visualizes the aorta in the abdomen using sound waves. It is safe, painless, does not use radiation, and is quite successful in detecting aneurysms. It is also used to measure and monitor the size of the aneurysm. This is the most commonly used method for screening.
• Computed Tomography (CT): Provides more detailed images. It shows the exact location, size, and relationship of the aneurysm with surrounding tissues. It is especially valuable for surgical planning. Usually, a contrast agent is injected through the arm for better visualization of the vessels (CT angiography).
• Magnetic Resonance Imaging (MRI): Provides detailed information like CT, but does not involve radiation. Sometimes, it is performed with a contrast agent (MR angiography).

Definitive diagnosis and characterization of the aneurysm are achieved through these imaging methods.

Should Everyone Who Feels a Heartbeat-Like Sensation in Their Stomach Be Screened for AAA?

No, not everyone needs to be screened. Screening recommendations are targeted at specific groups with higher risk. The goal is to detect aneurysms before they rupture, especially in those without symptoms.

According to current recommendations, men aged 65-75 who have ever smoked should have a one-time abdominal ultrasound screening for AAA. For men aged 65-75 who have never smoked, the decision should be made individually based on other risk factors and the doctor’s assessment. Routine screening is generally not recommended for women, as their risk is lower. However, keep in mind that these recommendations are for people without any symptoms. If you have symptoms such as a pulse sensation in your abdomen, you should definitely see a doctor, regardless of your age.

What Are the Symptoms of Reflux (GERD) That Can Be Confused with the Heartbeat-Like Sensation in the Stomach?

Although the pulse sensation in the abdomen is usually due to the aorta, other disorders in the upper abdomen or chest region can sometimes be signs of different conditions. Gastroesophageal Reflux Disease (GERD), the backflow of stomach acid into the esophagus, often causes discomfort in this region.

The most well-known symptoms of GERD are burning behind the breastbone (heartburn) and a bitter or sour liquid coming up into the mouth. However, GERD can sometimes present with other symptoms. Chest pain that can mimic heart pain, discomfort or pain in the upper abdominal area, difficulty swallowing, hoarseness, and persistent cough can also result from GERD. The location of these symptoms can sometimes overlap with the area where AAA pain is felt.

Is There a Connection Between the Heartbeat-Like Sensation in the Stomach and Hiatal Hernia?

There is no direct connection. A hiatal hernia is when the upper part of the stomach slides through the diaphragm opening into the chest cavity and does not cause a pulse sensation. However, especially large hiatal hernias can cause discomfort in the upper abdomen or chest, similar to GERD.

People with hiatal hernia often have reflux symptoms. There may also be a feeling of pressure in the chest, pain (sometimes resembling a heart attack), shortness of breath, difficulty swallowing, or early satiety after meals. Again, the important point here is that the area where the symptoms are felt (upper abdomen/lower chest) is the same area where AAA symptoms can be experienced. This may rarely cause diagnostic confusion.

How Is GERD Diagnosed in People with Upper Abdominal Discomfort but Without the Heartbeat-Like Sensation?

If your complaints are thought to be caused by GERD, your doctor will take several steps to clarify the diagnosis. Typically, your symptoms will be listened to first. If you have typical reflux complaints, a trial with Proton Pump Inhibitor (PPI) medications that suppress stomach acid may be recommended. If your symptoms improve with this medication, the diagnosis of GERD is largely confirmed.

However, if the diagnosis is unclear or if complications are suspected, endoscopy (gastroscopy) may be performed. With this procedure, the esophagus and stomach are directly visualized to check for any damage. Sometimes, especially in cases where there is no response to medication or surgery is being considered, more advanced tests such as 24-hour pH monitoring, which measures the amount of acid reaching the esophagus, may be required.

How Is Hiatal Hernia Diagnosed When Symptoms Overlap with the Heartbeat-Like Sensation?

If a hiatal hernia is suspected, the first-choice diagnostic method is usually a “barium swallow,” also known as a contrast X-ray of the stomach. You drink a liquid containing barium, and X-ray images are taken while you swallow. This shows the position of the stomach and whether a hernia is present, as well as its size.

Endoscopy (gastroscopy) can also help diagnose hiatal hernia. The doctor can see the hernia directly while looking at the stomach with a camera. Sometimes, especially in cases of large or complex hernias or for surgical planning, Computed Tomography (CT) may also be ordered. In both conditions (GERD and hiatal hernia), your doctor’s assessment and appropriate tests are essential for diagnosis.

What Are the Lifestyle and Medication Recommendations for People with Reflux but Without the Heartbeat-Like Sensation in the Stomach?

When diagnosed with reflux (GERD), treatment usually starts with lifestyle changes and medications. Losing weight (if you are overweight) and elevating the head of the bed are very important. It is helpful to avoid fatty, spicy foods, and triggers such as chocolate, coffee, and alcohol. Quitting smoking and not eating right before bedtime are also recommended.

Antacids that neutralize stomach acid can provide temporary relief. For more effective and longer-lasting control, your doctor will prescribe H2 blockers or, more commonly, Proton Pump Inhibitors (PPIs). PPIs are the most effective group of drugs for treating reflux.

When Is Surgery Considered for Reflux and Hiatal Hernia in Complaints Other Than the Heartbeat-Like Sensation?

If reflux complaints cannot be controlled despite lifestyle changes and medication, if you do not want to use medication continuously, or if there is severe damage or narrowing in the esophagus due to reflux, surgery becomes an option. Additionally, in cases of large and persistently symptomatic hiatal hernias, surgical treatment is generally recommended. The decision for surgery is made together with the doctor based on the patient’s condition, severity of symptoms, and preferences.

The goal of surgery is to repair the hiatal hernia and create a mechanism that prevents the contents of the stomach from flowing back into the esophagus.

What Are the Modern Methods in Reflux/Hernia Surgeries Unrelated to the Heartbeat-Like Sensation?

Today, reflux and hiatal hernia surgeries are mostly performed with “minimally invasive” methods, meaning with small incisions. The most common method is laparoscopic surgery. The procedure is performed through several small openings in the abdomen using a camera and special instruments. Compared to open surgery, this method offers less pain, faster recovery, and better cosmetic results.

Robotic surgery is another minimally invasive option. In this technique, the surgeon controls robotic arms from a console, and results are similar to laparoscopy, although costs may be higher. Sometimes a mesh is used to reinforce the hernia repair, but this is not always necessary and depends on the surgeon’s decision.

Dr. Ahmet Bekin

Op. Dr. Ahmet Bekin was born in Istanbul in 1983. He graduated from the Faculty of Medicine at Kocaeli University in 2006 and completed his specialty training in the Department of General Surgery at Istanbul University Çapa Faculty of Medicine in 2011. After his specialization, he worked in the fields of hernia surgery, reflux surgery, obesity surgery, advanced laparoscopic surgery, and robotic surgery. In addition, he received training in endocrine surgery, oncological surgery, and minimally invasive surgery. He is currently accepting patients from Turkey as well as from countries such as Germany and France at his private clinic located in Istanbul.