The feeling of a “skipped heart beat,” medically known as a heart palpitation, is a common sensation where the heart rhythm becomes noticeably irregular. This experience can manifest as a flutter, a pounding, or the brief feeling that the heart has paused and then rebooted with a heavy thump. While often startling, the majority of these events are transient and not indicative of a serious underlying health condition. Understanding the mechanics of this irregular rhythm helps determine if the sensation is benign or requires medical attention.
Understanding the Physiology of a Skipped Beat
The sensation of a skipped beat is rarely an actual pause in the heart’s function; it is typically an awareness of a premature contraction. This premature beat originates from an electrical impulse outside the heart’s natural pacemaker, the sinoatrial node. These extra beats are classified as Premature Atrial Contractions (PACs), originating in the upper chambers, or Premature Ventricular Contractions (PVCs), which start in the lower chambers.
The premature contraction occurs before the heart has fully relaxed and filled with blood, so the beat itself may feel weak or go unnoticed. Following this early beat, the heart’s electrical system undergoes a momentary reset, creating a longer-than-usual pause, known as a compensatory pause. During this extended pause, the heart’s lower chambers fill with extra blood volume. The next scheduled beat ejects this larger volume of blood with increased force, and this strong thump is what the person perceives as the “skipped” beat.
Common, Non-Threatening Causes of Palpitations
In a structurally healthy heart, the electrical system can be temporarily irritated by various external and internal triggers. Lifestyle factors are the most frequent culprits behind occasional palpitations. High levels of psychological stress, anxiety, or acute panic attacks flood the body with stimulating hormones like adrenaline, which can directly disrupt the heart’s normal rhythm.
Dietary stimulants are another cause. Excessive intake of caffeine—found in coffee, tea, and energy drinks—is known to increase heart rate and trigger irregularity. Nicotine, whether from smoking or replacement products, similarly acts as a stimulant, raising blood pressure and heart rate. Over-the-counter medications, particularly decongestants containing pseudoephedrine, can also stimulate the heart and cause palpitations.
Internal physiological changes often contribute to temporary palpitations. Hormonal fluctuations associated with the menstrual cycle, pregnancy, or menopause can increase the heart’s sensitivity to irregular beats. Systemic issues like dehydration, fever, or an imbalance of electrolytes such as potassium or magnesium can destabilize the heart’s electrical activity. Lack of sufficient sleep or a recent bout of strenuous exercise can also prompt premature beats in otherwise healthy individuals.
Red Flags: When Skipped Beats Signal Serious Danger
While most palpitations are harmless, certain accompanying symptoms serve as warning signs that require immediate medical evaluation. The most urgent red flags involve symptoms suggesting compromised blood flow or electrical instability. These include chest pain or severe discomfort, particularly if it radiates to the arm, neck, or jaw.
Palpitations combined with sudden, unexplained shortness of breath, especially when resting, can signal a significant heart or lung issue. Dizziness, lightheadedness, or fainting (syncope) indicate that the heart’s irregular rhythm is preventing sufficient blood flow to the brain. These symptoms suggest an arrhythmia is sustained or severe enough to cause hemodynamic instability.
Danger is also elevated when palpitations occur in individuals with a known history of structural heart disease, such as valve problems, heart failure, or a previous heart attack. Frequent, sustained runs of irregular beats, or those triggered by intense physical exercise, can be manifestations of more serious arrhythmias like ventricular tachycardia or atrial fibrillation. A family history of sudden cardiac death in younger relatives also elevates the risk profile.
Diagnostic Testing and Management Options
Evaluation of palpitations begins with a detailed medical history and a physical examination to check for signs like a swollen thyroid gland or abnormal heart sounds. Blood tests are typically ordered to check for non-cardiac causes, such as anemia, thyroid hormone abnormalities, or electrolyte imbalances.
To capture the heart’s electrical activity, a standard electrocardiogram (EKG) is performed, but continuous monitoring is often needed. A Holter monitor is a portable device worn for 24 to 48 hours. An event recorder can be worn for several weeks, activated only when the patient feels symptoms. An echocardiogram, which is an ultrasound of the heart, may also be used to assess the heart’s structure and function and rule out conditions like valve disease.
Management strategies are tailored to the diagnosis. If the palpitations are benign, treatment focuses on lifestyle modifications, such as reducing caffeine and alcohol intake and employing stress-reduction techniques. For persistent or serious arrhythmias, medical management may involve prescription medications, like beta-blockers, to control the heart rate and rhythm. In cases where a specific electrical short circuit is identified, a procedure like catheter ablation may be performed to eliminate the problematic tissue.