When Your Heart Skips a Beat

Health Professional

Not a week goes by that I don't see someone in cardiology consultation for skipping, jumpy heart beats.     It is a common problem- a problem that worries many people.

Why?   It's unnerving to feel your heart beating.

Most people are rarely aware of their heart's movement in their chests.   So when a person suddenly can feel their heart, thumping erratically it often sends them to the doctor.

Should you be worried?   Should you be concerned if you feel your heart missing a beat?

By and large skipping of the heart, what is called palpitations, are rarely serious.   The vast majority of skipped heartbeats are something called premature atrial complexes or PAC'S.   These are early heartbeats that generally arise from the upper chambers (the atria) of the heart.     Skipped beats can also arise from the lower chambers.

They can also be due to a fast heartbeat called a tachycardia.

Normally the electrical activity of the heart begins from a pacemaker cell called the sinus node located in the right atrium.   This is the heart's spark plug.   It fires regularly to begin the cardiac cycle.

PAC's are a premature activation of the atria from a site different from the normal spark plug.   They can occur singly, or in groups.   They are felt as the typical turning over of the heart, and are extremely common.   As I said, most people rarely feel them.

Yet, if they are felt it can seem strange, even unnerving.   PAC's by themselves are rarely dangerous.   Medical studies have shown that many people have skipped heartbeats.

PAC's show up in young people as well as older people.   You can find them in people with normal hearts and in people whose hearts are abnormal. 10-70% of normal people have PAC's.

In some people, however, they can lead to more serious cardiac arrhythmias.   PACs can start Atrial Fibrillation.       They may also be a sign of other heart conditions. If your heart muscle is weakened or you have an abnormality of the Mitral Valve (the valve between the left atrium and left ventricle) PAC's are very common

PAC's are also very common in other medical illnesses. People who suffer from lung disease frequently have skipped heartbeats.

Interestingly, PAC's are seen in the normal unborn fetus. They are also occur in healthy newborns. So having PAC's shouldn't overly worry you.

Another type of skipped beat is a Premature Ventricular Complex or PVC. PVCs arise from the lower chambers of the heart, the ventricles. They may be found in normal people but are much more frequent in people with abnormalities of the heart.

By themselves PVCs are not dangerous, but they may indicate other types of medical illness: high blood pressure, damaged heart muscle, Valvular conditions, heart failure, electrolyte abnormalities, and other conditions.

How Can I tell if I have skipped beats?

Obviously if you feel your heart skipping or jumping then you probably have PACs or PVCs. It's also possible that you have actual racing of the heart. Just feeling skipping, however, won't really tell you if your heart rhythm is actually abnormal. It also won't tell you what type of abnormality is occurring.

In order to know for certain you need to have a medical test. A number of medical tests are useful.

EKG: Your doctor can order an electrocardiogram. This is a test that shows the electrical conduction of the heartbeat. An EKG is like a snapshot of the heart rhythm. It is useful if the abnormal rhythm is present during the time that the EKG is done. But if the rhythm is not present it may not be helpful.

24 Hour Heart Monitor: Another test that can be performed is a 24-hour electrocardiogram. Here you wear a heart monitor that continuously records your heartbeat for 24 hours. Often the episodes that are causing skipped beats with be caught by this test. Yet, like the EKG if the abnormal rhythm isn't present during the time your heart skips then it can be missed.

Event Monitor: An event monitor is a heart beat recording device that is worn for 1-2 months. When a person feels a skipped beat, an episode of tachycardia, or has symptoms- they push a button and the device saves the episode.

All of these tests can be useful for determining what type of abnormality is present.

Key Points:

Skipped beats are rarely dangerous.

They may indicate PAC's, PVC's or could represent a tachycardia.

Even though they are not likely to be serious they may make a person feel strange or create unnerving sensations.

They can also indicate other cardiac problems.

Consult you doctor to sort through these issues.

Dr. Kirk Laman