Can Pectus Excavatum Cause Heart Problems? The Research

If you have a sunken chest and you’ve started noticing your heart racing, skipping or pulsing under your skin, it’s easy to assume the dent is squeezing it. For most people, it isn’t. The 2024 Pectus Care Guidelines, a consensus of specialist societies, describe most cases as mild and well tolerated. In a smaller group with more severe chests, the breastbone can press on the right side of the heart, and the effect shows up mainly during exercise rather than at rest.

Below, each symptom or habit people ask about gets a short answer, and where I couldn’t find research, I say so. If something is happening right now, go straight to when to get help.

New to the condition itself? Start with what pectus excavatum is. I was diagnosed with it at 15, declined surgery and corrected it over about three years of daily vacuum bell use and structured training. The change was visible and measurable, but not complete. I’m not a doctor, so every medical point below comes from a study or an official health source.

How pectus excavatum can affect the heart

The right side of your heart pumps blood to your lungs and sits closest to the front of your chest. When the breastbone grows inward, the heart gets pushed to the left, and in more severe chests the right side can be squeezed so it can’t fill fully. That lowers stroke volume, the amount of blood pushed out with each beat. Two studies show when it matters:

• A study of teenagers compared 49 with pectus excavatum and 26 without. At rest, their hearts worked the same. During moderate exercise, each beat in the pectus group moved less blood (42 against 54 mL, adjusted for body size), at the same heart rate.
• A German study of 99 otherwise healthy patients found a sequence. People with a Haller index above 3.25 had a higher heart rate at the same point of hard effort (156 against 148 beats a minute on average). Deeper chests showed signs of less blood per beat, and only above 4.0 did peak fitness fall.

(The Haller index is the severity number from a chest scan: about 2.5 is average, and 3.25 or more is usually called severe.)

My read: in a more severe chest, the heart can lean on beating faster to keep up during hard exercise, and the effect is modest. The breathing side is in pectus excavatum and shortness of breath.

Palpitations, skipped beats and a fast heart rate

Palpitations means noticing your heartbeat racing, pounding, fluttering or skipping. A “skipped beat” is often a PVC (premature ventricular contraction), an early extra beat from the heart’s lower chambers.

The NHS says palpitations are usually harmless, with common triggers such as hard exercise, stress and anxiety, lack of sleep, some medicines, alcohol, caffeine and nicotine. If yours arrive with worry, see anxiety and pectus excavatum.

In 124 people aged 10 to 19 with pectus excavatum, evaluated before surgery in Memphis, 33% had ECG changes during an exercise test, mostly PVCs (24%). The PVCs were linked to the right side of the heart being compressed on CT, not to the Haller index. A 2025 sports cardiology review cites another study that found PVCs in 34.9%. Both groups had already been sent for evaluation, so neither figure fits milder chests. On the calmer side, a 2016 review of heart imaging notes that people with pectus excavatum don’t share a tendency toward the dangerous kinds of ventricular arrhythmia.

As for a fast heart rate, Cleveland Clinic puts a normal resting rate at 60 to 100 beats a minute and calls more than 100 at rest tachycardia. I couldn’t find good evidence that pectus excavatum by itself raises resting heart rate (the teenage study found no difference at rest). A resting rate regularly over 100 is worth checking, whatever the cause. If your heart mainly races when you stand up, read about POTS.

A case report from the Netherlands describes an active 59-year-old man with palpitations and breathlessness after exercise, whose routine ECG caught a fast rhythm at 220 beats a minute. After years with no other explanation, he had a modified Ravitch procedure. His tiredness and breathlessness almost completely went away, and three months later he could exercise hard with only a minor arrhythmia. The authors’ advice: consider pectus excavatum when nothing else explains symptoms. One man, not a rule.

Can you see your heartbeat through your chest?

I couldn’t find research linking pectus excavatum to a heartbeat you can see.

A nursing health-assessment textbook says gentle pulsations on the chest wall can be normal in people with a thin chest wall, while a forceful heave needs further assessment.

So a soft flicker in a slim chest can be normal, and it’s fine to ask about at a routine check-up. If it’s forceful, new, or comes with breathlessness, chest pain or dizziness, get it checked sooner.

Heart murmurs and mitral valve prolapse

A heart murmur is an extra whooshing sound heard through a stethoscope. Cleveland Clinic says murmurs are common and most people had a harmless (“innocent”) one in childhood. Abnormal ones come from an underlying problem such as a faulty valve, sometimes with bluish skin, a lasting cough, chest pain, breathlessness or fainting.

Mitral valve prolapse (MVP) is when a valve’s flaps on the left side of the heart bulge back as they close, which can let a little blood leak and cause a click or murmur. It turns up more often with pectus excavatum, but how often depends on who’s counted:

• In a US surgical series of 1,215 people who had the Nuss procedure, 18% had MVP and 16% had an abnormal heart rhythm. These were chests severe enough for an operation.
• A 2024 meta-analysis pooling eight small imaging studies (303 people with pectus excavatum) found MVP in 40.6%, against 12.8% of people without it. It was about three times more common in children and young teens than in adults.

So the figure runs from about 18% to about 40%. That shows the two travel together, not that the dent causes the valve problem.

Marfan syndrome, a connective tissue condition that can affect the aorta and heart valves, may be present in up to 5% of people with pectus excavatum, according to the 2025 review (2.8% confirmed in that surgical series). If you have it, or a doctor has raised it, get your heart checked. More in Marfan syndrome and pectus excavatum.

Atrial fibrillation (AFib)

AFib is an irregular, often fast rhythm that starts in the heart’s upper chambers.

A 2013 study from the University of North Carolina compared 220 people having an AFib procedure (ablation) with 225 people without AFib. Those with “lone” AFib, meaning AFib without the usual causes such as high blood pressure or heart disease, were more than five times as likely as the other groups to have a severe sunken chest, and nearly two-thirds had at least a mild one. The authors suggested a genetic or mechanical cause the two might share.

The study comes from one center and shows an association. It doesn’t prove that pectus causes AFib. Case reports exist too, such as a 19-year-old whose CT showed an upper chamber being compressed. If you already have AFib, the alcohol research below applies most to you.

Dizziness, fainting and low blood pressure

The NHS defines low blood pressure as below 90/60. It can cause dizziness, blurred vision, weakness and fainting, and when that happens on standing it’s called postural hypotension. The NHS suggests getting up slowly, not bending down suddenly, drinking more water and going easy on alcohol, and seeing a doctor if dizziness or fainting keeps happening.

I couldn’t find a study on blood pressure in people with pectus excavatum, only a few case reports about posture. In the most dramatic, a 19-year-old with a severe chest, already booked for repair, fainted and went into a dangerous heart rhythm while bending forward for an epidural. Doctors found no cause other than his heart being compressed, repaired his chest, and he was well 18 months later. Afterward he recalled dizzy spells when tying his shoelaces.

His case is rare, and it doesn’t make this a typical risk. Still, if you get dizzy when you bend forward, tell a doctor.

Cold or purple hands and circulation

I couldn’t find research linking pectus excavatum to cold, pale or purple hands, or to circulation problems in general.

Fingers and toes that change color in the cold or under stress are typical of Raynaud’s, which the NHS describes as common and usually not serious, though sometimes it’s a sign of another condition. The NHS suggests seeing a doctor if it’s severe, getting worse, affects one side only or comes with joint pain, rashes or muscle weakness.

Can pectus excavatum cause high blood pressure?

I couldn’t find a study linking pectus excavatum to high blood pressure. That isn’t proof there’s no link, only that I found nothing published. Get a high reading rechecked and work out the cause with a doctor, rather than blaming your chest.

Caffeine, coffee and alcohol

I couldn’t find any study on caffeine or alcohol in people with pectus excavatum, so this section draws on research in other groups.

Caffeine and coffee

The most direct test is the CRAVE trial from 2023: 100 adults wearing heart monitors were told at random, day by day, to drink coffee or avoid it. On coffee days, extra beats from the upper chambers didn’t rise significantly, but PVCs did: 154 a day against 102.

The long-term picture is calmer. In UK Biobank, 386,258 adults followed for about 4.5 years, each extra daily cup of coffee was linked to a 3% lower risk of arrhythmia, AFib included. It’s an association, so it doesn’t prove coffee protects you.

The FDA says 400 mg a day, about two to three 12-ounce cups of coffee, isn’t generally linked to negative effects in most adults, though sensitivity varies. In children and teens, too much caffeine can cause a faster heart rate, palpitations, high blood pressure and anxiety.

My read: PVCs turned up in a quarter to a third of the people with pectus excavatum tested above, and coffee raised PVCs in CRAVE. So skipped beats after coffee have a plausible explanation, and cutting back is a fair experiment.

Alcohol

The strongest data come from people who already have AFib. In a 2020 trial in Australia, regular drinkers (10 or more drinks a week) with AFib were randomly assigned to stop or carry on. Over six months, AFib came back in 53% of those who stopped against 73% of those who kept drinking. A 2021 study of 100 people with on-and-off AFib found one drink was linked to double the odds of an episode within four hours.

For adults in general, the NHS advises no more than 14 units a week and says drinking more than that over many years raises the risk of heart disease and stroke.

Does pectus excavatum shorten your life?

There’s no good evidence that it does. Cleveland Clinic puts it this way: “There’s no evidence that pectus excavatum limits life expectancy or causes progressive damage to your heart and lungs over time.” It also gives the other half: without surgery, symptoms may get worse, and you may develop more of them as you age. I cover the long-term outlook separately.

When to get help

These lists come from the NHS chest pain and palpitations pages, Cleveland Clinic on palpitations and the red flags in my main guide.

Call 911 (999 in the UK) now if

Or your local emergency number. Don’t drive yourself.

• palpitations that won’t stop
• palpitations with chest pain, shortness of breath, feeling faint or fainting
• sudden chest pain or pressure that doesn’t go away
• chest pain that spreads to your arm, neck, jaw or back
• chest pain with sweating, feeling sick, light-headedness or breathlessness

If palpitations came with those symptoms but have now stopped, the NHS says to ask for an urgent doctor’s appointment (or call 111 in the UK).

See a doctor soon if

• your palpitations keep coming back, are getting more frequent, or last more than a few minutes
• you have a heart or lung condition, or a family history of heart problems
• you have chest pain that comes and goes
• you’ve fainted or nearly fainted, or get dizzy when you stand up or bend forward
• you’re breathless at rest or with light effort
• you’ve been told you have a murmur and nobody has explained it
• you have Marfan or Ehlers-Danlos syndrome, or a doctor has raised either
• you’ve had chest surgery before
• your Haller index is above 3.25 and you have symptoms
• you have symptoms nobody has checked yet

The NHS also points out that most chest pain isn’t from the heart. Chest wall pain has its own guide: pectus excavatum pain.

Who to see. Start with your family doctor or your child’s pediatrician. If they find something, or your chest is severe and you have symptoms, see a cardiologist for the heart and a pediatric or thoracic surgeon who works with chest wall conditions.

What heart tests look for

• ECG (electrocardiogram). Small pads on your chest record the heart’s rhythm, picking up extra beats.
• Echocardiogram. An ultrasound of the heart. It shows the valves, including MVP, how well each side pumps, and whether the breastbone is pressing on the heart.
• Exercise test (CPET). You exercise while your breathing and heart are measured.
• Cardiac MRI or CT. Images of how the chest sits against the heart, which also give the Haller index.

An odd-looking ECG is common with pectus excavatum and, as the 2025 review notes, can mimic serious heart disease. In 310 adults studied before and after repair at Mayo Clinic Arizona, 62% had one such pattern (T-wave inversion in the right-sided leads) before surgery and 38% after. If you get a worrying ECG report, make sure whoever reads it knows you have pectus excavatum.

X-rays can mislead too. On a front-on view the heart can look bigger than it is, because it’s pushed to the side. A side view shows the real picture.

Does fixing the chest help the heart?

The research genuinely disagrees.

Evidence that it helps. A 2006 meta-analysis of 8 studies (169 patients) found heart function improved significantly after repair. In a 2022 Mayo Clinic Arizona study, 68% of 392 adults had below-normal exercise test results before the Nuss procedure. The 130 retested about 3.4 years later had improved significantly, and in 39 who also had a heart ultrasound during surgery, the right ventricle pumped more blood per beat by the time the bar came out. There was no comparison group. The 2024 guidelines also cite their largest cohort as showing improvement.

Evidence that it doesn’t, or not reliably. A 2007 review argued the 2006 meta-analysis mixed in studies with unsuitable methods. Of five studies that measured the heart directly (118 patients), four found no improvement in heart size, blood per beat or output. The 2025 review also notes that not every study has found improvement.

Most of the positive data come from high-volume surgical centers, and single cases like the Dutch man above can’t predict yours.

And non-surgical correction? I couldn’t find a single study on whether a vacuum bell, exercise or any other non-surgical route changes heart function. If your main worry is your heart, that route isn’t a proven answer for it. Surgery has heart data behind it, even if disputed. The pectus excavatum surgery guide covers options and risks.

Rare heart problems after surgery

Cardiac tamponade is fluid or blood building up in the sac around the heart and pressing on it. It needs urgent treatment, and case reports describe it after pectus repair, sometimes long after:

• A 23-year-old woman in Korea had it twice, 16 and 18 months after her Nuss procedure. Doctors drained it, then opened a window in the sac and removed the bar, and she went home well.
• A 24-year-old man in the UK needed emergency surgery when a broken wire from a repair two years earlier worked into the sac.
• A 12-year-old boy with Marfan syndrome in Israel bled around the heart two years after repair, when a broken metal plate pierced the right atrium.

Single cases show it can happen, not how often, so know when to call. Children’s Hospital of Philadelphia, for example, tells families to call the team after a Nuss procedure for a fever over 101.5°F, redness, swelling or drainage at the incisions, trouble breathing, a change in how the chest looks, new or worse chest pain, or a chest injury.

The vacuum bell and your heart

A vacuum bell is a suction cup that lifts the breastbone while it’s on. It’s the route I took.

A review of the vacuum bell practice at a center in Basel lists cardiac disorders among its contraindications, alongside skeletal, blood vessel and bleeding disorders. That center routinely does an ECG and an echocardiogram before anyone starts daily use, and none of the side effects it lists involve the heart. That’s one center’s routine, not a universal rule. The 2024 guidelines call the bell safe with professional supervision.

With a diagnosed heart condition, or anything on the lists above, see a doctor first. The wider evidence is in vacuum bell therapy.

What to do next

• Anything on the emergency list. Call 911 (999 in the UK) or your local emergency number now.
• Anything on the “see a doctor soon” list. See a doctor before any device or program.
• Skipped beats after coffee or a few drinks, and nothing else. Cut back and see whether they settle. If they don’t, or other symptoms join them, see a doctor.
• No symptoms, or a mild dip. You’re in the biggest group. For a sense of how significant yours is and which route fits, take my free 1-minute quiz.
• Your heart checks out and you want to work on your chest without surgery. See pectus excavatum treatment without surgery.

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