The sensation of a “skipped heart beat,” often described as a flutter, thump, or an unusual awareness of one’s heartbeat, is common. These heart palpitations can feel unsettling because heart activity is usually not consciously perceived. Though surprising, such sensations are frequently harmless. Understanding their mechanisms can help demystify this widespread occurrence.
Understanding a Skipped Beat
A “skipped beat” doesn’t mean the heart actually misses a beat. Instead, it’s typically an extra heartbeat (a premature beat) followed by a brief pause. These premature beats originate in the atria (PACs) or ventricles (PVCs). These extra beats occur earlier than the next expected regular heartbeat.
After this premature contraction, the heart often pauses slightly longer to reset its rhythm. This longer pause, called a compensatory pause, allows chambers to fill with more blood. The subsequent beat feels stronger or like a “thump” as the heart ejects this increased blood volume. This sequence creates the sensation of the heart “skipping” or “pounding.”
Common Triggers and Underlying Factors
Many factors contribute to skipped heartbeats, from daily habits to medical conditions. Emotional responses like stress, anxiety, or panic attacks are frequent contributors, releasing hormones that affect heart rate. Lifestyle choices also play a role, with caffeine, alcohol, and nicotine known to overstimulate the heart and trigger palpitations.
Physical factors like dehydration, insufficient sleep, and intense exercise can also induce these sensations. Certain medications, including decongestants, asthma inhalers, and some cold and cough remedies, may contain stimulants leading to palpitations. Hormonal changes during menstruation, pregnancy, or menopause can also influence heart rhythm due to estrogen and progesterone fluctuations.
Though often benign, skipped beats can be associated with underlying health issues. Conditions like an overactive thyroid (hyperthyroidism), anemia, or electrolyte imbalances (potassium, sodium, calcium, magnesium) can affect the heart’s electrical signals. Heart conditions, including irregular heart rhythms (arrhythmias) like atrial fibrillation or structural heart problems, may also manifest as skipped beats.
When to Seek Medical Advice
While occasional skipped heartbeats are often harmless, certain symptoms or patterns warrant medical evaluation. Consult a healthcare professional if palpitations occur frequently or persist for more than a few seconds or minutes. A doctor’s visit is also recommended if sensations are new, worsening, or occur with a history of heart disease or significant risk factors.
Immediate medical attention is necessary if skipped beats accompany concerning symptoms. These include chest pain or discomfort, shortness of breath, dizziness, or lightheadedness. Fainting or near-fainting, unusual sweating, or severe fatigue also require urgent medical assessment. These symptoms could indicate a serious underlying heart condition needing prompt diagnosis and treatment.
Diagnosis and Management Approaches
When evaluating skipped heartbeats, a healthcare provider typically begins with a physical examination and a review of your medical history and symptoms. Blood tests may be performed to check for conditions like anemia, thyroid issues, or electrolyte imbalances. To assess the heart’s electrical activity, an Electrocardiogram (ECG or EKG) is often conducted, a quick test measuring electrical signals.
For intermittent palpitations not occurring during a brief ECG, extended monitoring devices can be used. A Holter monitor is a portable ECG device worn for 24 hours or longer to record heart rhythm during daily activities. If symptoms are less frequent, an event recorder may be recommended, worn for up to 30 days and activated by the patient when symptoms occur. An echocardiogram, using sound waves to create moving images of the heart, can assess its structure and function.
Management often begins with lifestyle modifications, especially if benign triggers are identified. Reducing or eliminating stimulants like caffeine, alcohol, and nicotine can help decrease the frequency of palpitations. Stress reduction techniques like meditation, yoga, or deep breathing exercises are also beneficial. Ensuring adequate hydration and sleep can further support heart rhythm.
If an underlying medical condition is found, treating that issue is the primary management strategy. For example, correcting thyroid dysfunction or electrolyte imbalances can resolve associated palpitations. If premature beats are frequent, bothersome, or linked to certain heart conditions, medications like beta-blockers or calcium channel blockers may be prescribed to regulate heart rhythm. Rarely, for severe or persistent arrhythmias, procedures like catheter ablation might be considered to target the source of the irregular beats.