The feeling that your heart has momentarily paused, fluttered, or performed a sudden “flip-flop” is known as a palpitation. This sensation is extremely common and can be felt in the chest, throat, or neck. Palpitations may involve a momentary racing, pounding, or irregular beat. In the vast majority of cases, these moments are benign and do not signal a serious underlying heart problem. Understanding the physical mechanism behind this feeling can help demystify the experience.
The Physiology of a “Skipped Beat”
The sensation of a “skipped beat” is actually caused by an extra heartbeat, not a missed one. This extra beat is medically known as a premature contraction, originating outside the heart’s normal electrical starting point. If the impulse originates in the upper chambers (atria), it is called a Premature Atrial Contraction (PAC). If the impulse starts in the lower chambers (ventricles), it is a Premature Ventricular Contraction (PVC).
Following the premature beat, the heart’s electrical system briefly resets, causing a longer-than-normal compensatory pause. During this extended pause, the heart’s chambers fill with more blood than usual. The next normal beat pumps a larger volume of blood, resulting in a noticeably forceful contraction. This strong “thump” is what most people interpret as the heart “skipping” or heavily “pounding.”
Common Triggers and Lifestyle Factors
Premature heartbeats are frequently linked to temporary external factors that influence the body’s nervous system. High levels of stress and anxiety are frequent triggers, causing the release of hormones like adrenaline that heighten cardiac activity. A lack of adequate sleep can also disrupt the body’s balance and lead to an increased frequency of these beats.
The consumption of stimulants is another common culprit, as substances like caffeine, nicotine, and alcohol can directly overexcite the heart muscle. Dehydration and imbalances in electrolytes, such as potassium and magnesium, are known to disturb the heart’s electrical stability. Certain over-the-counter medications, including cold remedies that contain decongestants, can also trigger palpitations as a side effect. Adjusting these lifestyle factors often helps reduce the frequency of the sensations.
When Palpitations Indicate a Deeper Concern
While most palpitations are harmless, they can occasionally signal a more serious underlying medical issue. The presence of other specific symptoms serves as a warning sign. Seek immediate medical attention if palpitations are accompanied by chest pain, severe shortness of breath, or severe dizziness or fainting (syncope).
Palpitations that are persistent, prolonged, or significantly worsening should prompt a medical evaluation. Structural heart diseases, such as coronary artery disease, valve problems, or cardiomyopathy, can predispose a person to more significant arrhythmias. Conditions affecting the entire body, including an overactive thyroid (hyperthyroidism) or electrolyte imbalance, can also be the root cause. Complex rhythm disturbances, like atrial fibrillation or ventricular tachycardia, may also present as palpitations and require prompt diagnosis.
Next Steps and Medical Consultation
If you experience palpitations that are frequent, persistent, or accompanied by concerning symptoms, a medical consultation is warranted. The diagnostic process begins with a thorough physical examination and a review of your medical history, diet, and medication use. Blood tests are often performed to check for issues like thyroid dysfunction, anemia, or abnormal electrolyte levels.
To capture the heart’s electrical activity during a symptomatic episode, physicians may order specialized monitoring tests. An Electrocardiogram (EKG or ECG) provides a snapshot of the heart’s rhythm. A Holter monitor is a portable device worn for a day or two to record continuous activity, while an event recorder may be used for up to a month for less frequent episodes.
Treatment, if required, is determined by the underlying cause. This can range from reinforced lifestyle modifications to prescribed medications, such as beta-blockers. In rare cases, interventional procedures like ablation may be used to correct the rhythm.