Does Fatty Liver Cause Heart Palpitations?

Fatty liver disease and heart palpitations are more closely connected than many people realise. Does fatty liver cause heart palpitations? While it is not a direct cause in the way a cardiac arrhythmia is, metabolic-associated steatotic liver disease (MASLD) creates an inflammatory and metabolic environment that significantly raises the likelihood of experiencing palpitations. Shared risk factors including insulin resistance, obesity and dyslipidaemia link the two conditions, and research consistently shows a higher prevalence of atrial fibrillation in people with fatty liver disease. Understanding this relationship is important for anyone managing both conditions.

Can fatty liver disease actually cause heart palpitations?

Fatty liver disease does not directly cause palpitations but creates a metabolic environment, through insulin resistance, inflammation and dyslipidaemia, that meaningfully raises the risk of arrhythmias including atrial fibrillation.

Fatty liver disease does not directly cause heart palpitations in the way that a cardiac arrhythmia does, but the two conditions share overlapping mechanisms that mean people with fatty liver disease are more likely to experience palpitations than those without it. Metabolic-associated steatotic liver disease (MASLD, formerly known as non-alcoholic fatty liver disease or NAFLD) is closely linked to insulin resistance, obesity, dyslipidaemia and chronic low-grade inflammation, all of which are independently associated with abnormal heart rhythms, including atrial fibrillation.^[1][2]

Systematic reviews and meta-analyses, including research published in major cardiology journals, have found that people with MASLD have a meaningfully higher prevalence of atrial fibrillation compared with the general population, even after adjusting for shared risk factors such as obesity and type 2 diabetes. This is an association rather than a proven direct causal relationship; the inflammatory signals and metabolic disturbances generated by a fatty liver appear to place additional stress on cardiac tissue, which may alter the electrical conduction system of the heart.

It is also worth noting that many people with fatty liver disease take medications or have nutritional deficiencies (such as low magnesium or potassium) that can themselves provoke palpitations. Common precipitants in UK practice include caffeine, alcohol, decongestants containing pseudoephedrine, salbutamol overuse, and excess or undertreated levothyroxine. Thyroid disease is a particularly important reversible cause of palpitations and should be considered in any assessment. Anxiety, which is more common in people managing chronic conditions, is another frequent trigger. So while fatty liver disease is not a direct, isolated cause of palpitations in the clinical sense, it creates a metabolic environment in which palpitations are more likely to occur. Anyone experiencing frequent or distressing palpitations alongside a known liver condition should discuss this with their GP rather than assuming the two are unrelated.

Why do the liver and heart affect each other?

The liver and heart are linked via the cardiohepatic axis; inflammatory cytokines, lipid abnormalities and insulin resistance generated by fatty liver disease promote endothelial dysfunction, arterial stiffness and cardiac arrhythmias.

The liver and heart are physiologically interdependent, connected through shared blood supply, metabolic signalling and inflammatory pathways, which is why disease in one organ frequently affects the other. This relationship is sometimes described as the cardiohepatic axis. The liver processes lipids, regulates glucose, filters inflammatory mediators and produces proteins that influence blood clotting and vascular tone, all of which have direct consequences for cardiovascular function.

In fatty liver disease, excess fat accumulates within hepatocytes (liver cells), triggering oxidative stress and the release of pro-inflammatory cytokines such as tumour necrosis factor-alpha (TNF-alpha) and interleukin-6. These circulating inflammatory signals are associated with endothelial dysfunction, arterial stiffness and myocardial inflammation. Over time, this may contribute to structural changes in the heart, including left ventricular dysfunction and an increased susceptibility to arrhythmias.

The liver also plays a central role in lipid metabolism. In MASLD, dyslipidaemia (particularly elevated triglycerides and low HDL cholesterol) is common, and these lipid abnormalities are associated with accelerated atherosclerosis, narrowing the coronary arteries and reducing the heart's blood supply. Insulin resistance, which underpins both conditions, further disrupts the normal hormonal environment that keeps heart rhythm stable.

Additionally, the portal venous system connects the gut and liver directly, and gut-derived bacterial products (endotoxins) that leak into the bloodstream in people with liver disease can activate systemic inflammation. This gut-liver-heart axis is an active area of research. European and UK hepatology and cardiology bodies, including the European Association for the Study of the Liver (EASL) and the British Society of Gastroenterology (BSG), recognise MASLD as being associated with increased cardiovascular risk, and cardiovascular disease is the leading cause of death in people with MASLD.^[4]

What other symptoms often appear alongside palpitations in fatty liver?

Fatigue, upper right abdominal discomfort, breathlessness on exertion, brain fog, disturbed sleep and swollen ankles are symptoms that may accompany palpitations in fatty liver disease, though all require clinical assessment.

People with fatty liver disease who experience palpitations often report a cluster of other symptoms that reflect the underlying metabolic and inflammatory burden on the body. It is important to note that these symptoms are non-specific and may have other causes; they should always be assessed by a clinician rather than attributed to fatty liver disease alone.

Symptoms that may accompany palpitations in fatty liver disease include:

• Fatigue and low energy: Persistent tiredness is one of the most frequently reported symptoms of MASLD, often disproportionate to the level of physical activity.

• Discomfort or heaviness in the upper right abdomen: This may reflect an enlarged or inflamed liver, though upper abdominal discomfort has many causes and warrants clinical assessment.

• Breathlessness on exertion: This is multifactorial and may reflect early cardiac involvement, deconditioning associated with obesity, or other conditions; it should be evaluated rather than assumed to be liver-related.

• Brain fog and difficulty concentrating: Linked to metabolic dysregulation and poor sleep quality, though again non-specific.

• Disturbed sleep or sleep apnoea: Obstructive sleep apnoea (OSA) is strongly associated with both MASLD and cardiac arrhythmias, and can itself trigger nocturnal palpitations. Assessment for OSA is worthwhile where symptoms suggest it, in line with NICE guidance.

• Increased thirst and frequent urination: These may point to coexisting insulin resistance or type 2 diabetes.

• Swollen ankles: In more advanced liver disease, fluid retention can occur, and this may also signal cardiac involvement.

Fatty liver disease is often described as a silent condition, particularly in its earlier stages, and many people have no symptoms at all. Palpitations that arise in this context should not be dismissed as anxiety or stress without proper clinical evaluation, especially if they are frequent, prolonged or associated with dizziness or chest discomfort.

When should you see a doctor about palpitations and liver problems?

See your GP if palpitations are new, frequent or prolonged, especially with a known liver condition; initial assessment should include a 12-lead ECG, blood tests and liver fibrosis risk scoring using FIB-4.

You should contact your GP if you are experiencing palpitations that are new, frequent, prolonged or accompanied by other symptoms, particularly if you have a known diagnosis of fatty liver disease or metabolic risk factors such as obesity, type 2 diabetes or high blood pressure. Early assessment allows your doctor to distinguish between benign causes (such as caffeine, dehydration or anxiety) and those requiring further investigation.

Your GP may arrange:

• An electrocardiogram (ECG): To assess heart rhythm and detect arrhythmias such as atrial fibrillation. NICE CKS guidance on palpitations recommends offering a 12-lead ECG as part of the initial assessment.^[5]

• Blood tests: Including liver function tests, fasting glucose, HbA1c, lipid profile, full blood count, electrolytes (magnesium, potassium) and thyroid function tests (TSH and free T4), which can identify metabolic and hormonal contributors to both liver disease and palpitations. Thyroid disease is a common and reversible cause of palpitations that should not be overlooked.

• Liver fibrosis risk assessment: Your GP may calculate a FIB-4 score using routine blood results to assess the degree of liver scarring, in line with NICE guideline NG49 on NAFLD assessment and management. Depending on the result, referral to a hepatology or liver service may be recommended.

• An abdominal ultrasound: To assess liver size, echogenicity and the degree of fatty infiltration.

• Ambulatory ECG monitoring: If palpitations are intermittent and not captured on a standard ECG, your GP may arrange a 24-hour or 48-hour Holter monitor. Where symptoms are infrequent, longer-duration event or patch monitors (typically 7 to 14 days) may be more appropriate, guided by how often you experience symptoms.

Seek emergency care by calling 999 if palpitations are accompanied by chest pain, collapse, loss of consciousness or severe breathlessness, as these may indicate a serious cardiac event requiring immediate attention. For urgent but non-emergency concerns outside GP hours, NHS 111 can provide advice and direct you to the appropriate service.

If you suspect that a medication you are taking may be contributing to your palpitations, you can report this to the MHRA via the Yellow Card scheme at yellowcard.mhra.gov.uk.

Lifestyle changes that can help both your liver and your heart

A Mediterranean-style diet, at least 150 minutes of moderate exercise per week and a 7 to 10 per cent reduction in body weight are the most evidence-based steps to improve both fatty liver disease and cardiovascular health simultaneously.

Sustained lifestyle modification is the most evidence-based intervention for improving both fatty liver disease and cardiovascular health simultaneously, and even modest changes can produce meaningful clinical benefits. NICE guideline NG49 on NAFLD assessment and management highlights diet, physical activity and weight management as the cornerstones of treatment.^[5][6]

Diet: A Mediterranean-style diet, rich in vegetables, legumes, wholegrains, oily fish and olive oil, and low in ultra-processed foods, refined sugars and saturated fats, has been shown in systematic reviews and meta-analyses to reduce liver fat, improve insulin sensitivity and lower cardiovascular risk markers.^[8] Reducing alcohol intake is also important, as alcohol worsens liver inflammation and can directly trigger palpitations by disrupting cardiac electrical activity.

Physical activity: Both aerobic exercise (such as brisk walking, cycling or swimming) and resistance training have been shown in meta-analyses to reduce liver fat independently of weight loss. NHS Live Well guidance recommends at least 150 minutes of moderate-intensity activity per week for adults.^[9] Regular exercise is also associated with reduced atrial fibrillation risk and improved heart rate variability.

Weight management: NICE NG49 notes that a weight loss of 7 to 10 per cent of body weight is associated with significant reductions in liver fat and inflammation.^[5] For people who struggle to achieve this through lifestyle changes alone, a GP can discuss whether pharmacological support or referral to a specialist weight management service is appropriate. Bolt Pharmacy is a GPhC-registered UK online pharmacy offering online weight-management consultations, with prescriber review and pharmacist support, as one option for people exploring structured support.

Sleep and stress: Treating obstructive sleep apnoea, where present, may reduce both liver inflammation and arrhythmia burden, though the strength of evidence varies and treatment decisions should be guided by a clinician. Managing stress through evidence-based approaches such as cognitive behavioural therapy (CBT) or mindfulness can also help reduce palpitation frequency.

Scientific References

1. A multisociety Delphi consensus statement on new fatty liver disease nomenclature.
2. Understanding the evolving nomenclature of steatotic liver disease.
3. MASLD Is Associated With an Increased Long-Term Risk of Atrial Fibrillation: updated meta-analysis.
4. EASL-EASD-EASO Clinical Practice Guidelines on the Management of Metabolic Dysfunction-Associated Steatotic Liver Disease.
5. Metabolic dysfunction-associated steatotic liver disease (MASLD): assessment and management (NG49).
6. Liver disease quality standard: advice on physical activity, diet and alcohol (QS152).
7. Non-alcoholic fatty liver disease (NAFLD).
8. Does the Mediterranean Diet Have Any Effect on Lipid Profile and Liver Outcomes in NAFLD Patients? Systematic review and meta-analysis.
9. Physical activity guidelines for adults aged 19 to 64 – NHS Live Well.

Frequently Asked Questions