When Your Heart Skips a Beat

Health Professional
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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 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 is something called a premature atrial complex (PAC). It is defined by early heartbeats that generally arise from the upper chambers (the atria) of the heart. Skipped beats can also arise from the lower chambers or from 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 is a premature activation of the atria from a site different from the normal spark plug. It can occur singly, or in groups. It is felt as the typical turning over of the heart and is extremely common. As I said, most people rarely feel it.

Yet, if it is felt it can seem strange, even unnerving. PAC by itself is rarely dangerous. Medical studies have shown that many people have skipped heartbeats.

PAC shows up in young people as well as older people. You can find it in people with normal hearts and in people whose hearts are abnormal.

In some people, however, it can lead to more serious cardiac arrhythmias. PAC can start atrial fibrillation. It 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 is very common.

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

Interestingly, PAC is also seen in the normal unborn fetus. It also occurs in healthy newborns. So having PAC shouldn't overly worry you.

Another type of skipped beat is a premature ventricular complex (PVC). PVC 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:

Electrocardiogram (EKG): 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 test. Here you wear a specfic heart monitor, called a Holter 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.

Final thoughts:

  • Skipped beats are rarely dangerous.
  • They may indicate a premature atrial complex (PAC), premature ventricular complex (PVC), or 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.