That sudden flutter or “skipped beat” feeling is almost always caused by an extra heartbeat firing slightly early, followed by a longer-than-normal pause before the next one. The pause is what you actually feel, and it can be startling. These extra beats are called premature contractions, and they’re remarkably common: a population-based study of healthy adults aged 25 to 41 found at least one on a 24-hour heart monitor in 69% of participants.
In the vast majority of cases, these beats are harmless. But understanding why they happen, what makes them worse, and which symptoms actually warrant concern can help you stop worrying about the ones that don’t matter.
What’s Actually Happening in Your Heart
Your heart has a built-in pacemaker in the upper chambers that sends a steady electrical signal to keep everything beating in rhythm. A skipped beat happens when a different spot in the heart fires off its own signal before the pacemaker does. If that rogue signal comes from one of the lower chambers, it’s called a premature ventricular contraction (PVC). If it comes from an upper chamber, it’s a premature atrial contraction (PAC). Either way, the early beat is usually weaker because the heart hasn’t had time to fill with blood completely. Then the heart pauses slightly longer than usual to reset its rhythm, and the next beat hits harder to make up for it.
That stronger beat after the pause is the “thump” most people notice. Some describe it as a flip-flop, a flutter, or the sensation that their heart momentarily stopped. It didn’t stop. It just took a brief detour.
Common Triggers
Several everyday factors can increase how often these extra beats fire. The most common is stress and anxiety. When your body’s fight-or-flight system kicks in, it releases adrenaline and related hormones that make heart cells more excitable. An overactive stress response can provide both the spark (the early beat) and the conditions that make it more likely to happen again, particularly in people who are already prone to them.
Other well-established triggers include:
- Caffeine in coffee, energy drinks, or tea
- Alcohol, even in moderate amounts
- Nicotine from smoking or vaping
- Poor sleep or fatigue
- Spicy food, which can stimulate the vagus nerve near the heart
- Hormonal shifts, including pregnancy
Some people also notice more palpitations when lying on their left side at night. This likely happens because that position places the heart closer to the chest wall, making normal and abnormal beats feel more noticeable.
How Electrolytes Play a Role
Your heart’s electrical system depends on minerals like potassium and magnesium to fire signals correctly. When levels of either drop too low, the electrical behavior of heart cells changes in ways that promote extra beats. Low potassium slows how quickly cells reset between beats and can create uneven electrical signals. Low magnesium compounds the problem, especially when other mineral levels are also off.
You don’t need a dramatic deficiency for this to matter. Mild drops from heavy sweating, diuretic use, poor diet, or stomach illness can be enough to nudge the heart into producing more extra beats than usual. If you’ve noticed an uptick in skipped beats after a bout of dehydration or during a stretch of poor eating, electrolyte balance is worth considering.
When Skipped Beats Are Harmless
For most people, they are. The median number of extra beats in healthy young adults wearing a heart monitor for 24 hours was just two in the entire day. Even at the high end, the 95th percentile was 193, which sounds like a lot but represents a tiny fraction of the roughly 100,000 beats your heart produces daily. Research from the American Heart Association found that patients with an extra-beat burden below 5% of total heartbeats can be reassured with no further follow-up. No patients with a burden under 10% developed heart muscle weakness in the studies reviewed.
Occasional skipped beats with no other symptoms, especially in someone with no known heart disease, are almost always benign.
Signs That Need Medical Attention
The extra beats themselves are rarely the problem. What matters is whether they come with other symptoms or happen frequently enough to strain the heart. Seek emergency care if skipped beats are accompanied by chest pain lasting more than a few minutes, dizziness or fainting, or significant shortness of breath. These combinations can signal a more serious rhythm disturbance or an underlying heart condition.
On the non-emergency side, it’s worth seeing a doctor if you feel skipped beats many times a day, every day, or if the sensation has become noticeably worse over weeks. When extra beats consistently make up more than 10% of all heartbeats over a 24-hour period, about 40% of those patients go on to develop weakening of the heart muscle over the following 15 years. That’s a meaningful risk, and it’s treatable when caught early.
How Doctors Investigate
The primary tool is a portable heart monitor you wear at home. The classic version is the Holter monitor, which records every heartbeat for 24 to 48 hours. Newer adhesive patch monitors work similarly but can be worn for up to two weeks, which is useful when symptoms are infrequent. Both are painless. You go about your day while the device captures the exact type and frequency of any irregular beats. An EKG in the office only records about 10 seconds of your heart’s activity, so it often misses extra beats that happen sporadically.
The monitor tells your doctor how many extra beats you’re having, where in the heart they originate, and whether they occur in concerning patterns. That information determines whether any treatment is needed.
Reducing Skipped Beats
If your extra beats are benign, lifestyle changes are usually the first and only step. Cutting back on caffeine, alcohol, and nicotine eliminates the most common chemical triggers. Stress management through practices like meditation, yoga, or breathing exercises can dial down the adrenaline response that makes heart cells more irritable. Staying well hydrated and eating enough potassium-rich foods (bananas, potatoes, leafy greens) and magnesium-rich foods (nuts, seeds, whole grains) helps keep the heart’s electrical system stable.
When extra beats are frequent enough to cause symptoms or risk heart muscle damage, doctors may prescribe medication that blocks adrenaline’s effect on the heart, slowing the heart rate and making it less reactive to triggers. For patients with a persistently high burden of extra beats that doesn’t respond to medication, a procedure called catheter ablation can target and disable the small patch of tissue producing the rogue signals. It has a high success rate, and reducing the extra-beat burden below 5% is associated with recovery of heart muscle function in patients who had begun to develop weakness.