The sensation of a “skipped heartbeat” is a very common experience, medically known as a heart palpitation. This feeling can manifest as a flutter, a pause, or a sudden, forceful thump in the chest, throat, or neck. While often alarming, these brief episodes are typically harmless and do not indicate a serious underlying condition. Understanding the mechanics of these momentary disruptions helps clarify when they are normal and when medical attention may be necessary.
The Science Behind the Sensation
The heart’s rhythm is governed by an electrical impulse that begins in the sinoatrial (SA) node, the body’s natural pacemaker, triggering a regular cycle of contraction. A skipped beat is rarely a missed contraction; instead, it is usually a premature contraction that disrupts the normal sequence. These premature beats are categorized by their origin: Premature Atrial Contractions (PACs) start in the upper chambers (atria), while Premature Ventricular Contractions (PVCs) start in the lower chambers (ventricles).
A premature beat occurs earlier than expected, causing the heart to fill with less blood than usual, which may result in a weak pulse. The heart then takes a slightly longer compensatory pause to reset its rhythm before the next normal beat. This pause allows the heart to fill with more blood, causing the subsequent normal contraction to be stronger and more noticeable. This strong beat is what is commonly perceived as the “skip” or “thump.”
This mechanism of an early beat followed by a strong beat is why the experience is often described as a “flip-flop” or a “pounding” sensation. The premature contractions disrupt the heart’s regularity. For people with an otherwise healthy heart structure, these premature beats are generally benign.
Common Triggers and Lifestyle Factors
Most skipped beats are provoked by external factors that temporarily stimulate the heart’s electrical system. High levels of stress, anxiety, or a panic attack are frequent causes, as the body releases adrenaline and other stress hormones. This “fight or flight” response increases heart rate and makes the heart more susceptible to premature beats.
Dietary stimulants are another common culprit, primarily excessive consumption of caffeine from coffee, energy drinks, or tea. Nicotine and alcohol also act as stimulants that disrupt the heart’s rhythm and increase palpitations. Dehydration and electrolyte imbalances, such as low levels of potassium or magnesium, can also affect the heart muscle’s electrical stability.
Certain over-the-counter and prescription medications, including decongestants and some asthma inhalers, can stimulate the heart and lead to palpitations. Hormonal changes, particularly fluctuations in estrogen during the menstrual cycle, pregnancy, or menopause, also increase the heart’s sensitivity to rhythm disturbances. Ensuring adequate sleep and managing vigorous exercise are simple lifestyle adjustments that can reduce the frequency of these palpitations.
When Skipped Beats Signal a Deeper Issue
While most palpitations are harmless, certain accompanying symptoms serve as “red flags” that require prompt medical evaluation. Palpitations are concerning if they are accompanied by severe chest pain, significant shortness of breath, or fainting (syncope). Skipped beats that occur during intense physical exertion or that are sustained, lasting longer than a few seconds, should also be checked by a healthcare provider.
These concerning symptoms can point toward a more serious, underlying cardiac condition, such as an irregular heart rhythm (arrhythmia) like atrial fibrillation or ventricular tachycardia. Structural heart disease, including abnormal heart valves or coronary artery disease, can also make the heart more vulnerable to dangerous electrical activity. Conditions outside the heart, such as severe thyroid disorder (hyperthyroidism) or profound anemia, can also cause persistent palpitations.
If the heart is already weakened or damaged, frequent PVCs can mark a more dangerous circuit forming, potentially leading to life-threatening rhythm disturbances. Sustained ventricular tachycardia, a rapid rhythm originating in the lower chambers, can lead to vascular collapse and requires immediate emergency care. Seeking evaluation for any palpitation that is frequent, worsening, or associated with these severe symptoms is necessary.
Medical Evaluation and Treatment
A medical evaluation for palpitations typically begins with a thorough physical examination and a review of the patient’s medical history, focusing on lifestyle factors and medication use. Blood tests are often performed to check for non-cardiac causes like anemia, thyroid hormone imbalances, or electrolyte deficiencies. These tests can often pinpoint a straightforward, treatable cause for the palpitations.
The primary diagnostic tool is the electrocardiogram (ECG or EKG), which measures the heart’s electrical activity at rest, though it may miss infrequent palpitations. If palpitations are not captured on the initial ECG, a portable monitor may be used. A Holter monitor records the heart’s rhythm continuously for 24 to 48 hours. For less frequent episodes, an event recorder can be worn for up to a month, requiring the patient to press a button when symptoms occur to capture the rhythm.
Treatment is determined by the underlying cause, often starting with non-medical interventions if the heart is structurally healthy. This involves reducing or eliminating known triggers like caffeine, alcohol, and nicotine, and implementing stress management techniques. If an underlying heart rhythm problem is identified, medications such as beta-blockers may be prescribed to slow the heart rate and reduce the frequency of premature beats. For serious or persistent arrhythmias, specific anti-arrhythmic medications or procedures like catheter ablation may be necessary to correct the electrical issue.