The normal heart keeps a regular rate and rhythm set by its main pacemaker. If the rhythm of your heart becomes irregular, you can sense this as palpitations and/or skipped beats. Most often these are benign but in some cases, they may be cause for concern; especially if they are prolonged and you have additional symptoms.
Why the Heart Skips Beats
A benign skipped heartbeat most commonly follows one that comes too soon in the regular rhythm of your heart. The irregular, premature contraction can cause the heart to skip a beat to compensate.
According to the Texas Heart Institute, these transient skipped beats can be the result of premature atrial contractions (PACs) or premature ventricular contractions (PVCs). Other types of irregular heart rhythms (arrhythmias) can also cause the heart to skip effective beats.
Other Abnormal Heart Rate and Rhythms
The American Heart Association (AHA) notes some cases of a sensation of skipped beats can be due to a more concerning underlying abnormal heart rate or rhythm. These can be caused by problems with the heart's pacemakers, electrical conducting system, or its muscle fibers.
Based on the above Texas Heart Institute reference, the abnormalities in heart rate or rhythm can include:
- Prolonged atrial or ventricular tachycardia (fast heart rate)
- Atrial fibrillation
- Ventricular fibrillation, which is the most dangerous arrhythmia and can cause sudden death
The sensation of skipped beats can occur because the heart is not pumping effectively.
Common Causes of Skipped Beats
Most of the problems that cause heart palpitations and skipped beats are benign and easily treated. Other causes are more worrisome and can put your life at risk. It is important to identify and treat the specific cause when the problem is prolonged or recurs often.
Some benign triggers of palpitations and skipped beats that Harvard Health lists include the following:
- Stress, anxiety, or panic attacks
- Exercise and other movements, such as standing up from sitting
- Low potassium, low blood sugar, dehydration, fever
- Over-indulgence in nicotine, caffeine, chocolate, or alcohol
- Pregnancy, which increases the metabolic rate and the work of the heart
- Prolapse of the mitral valve in the heart
Fear or other intense emotions can also cause the sensation of the heart skipping a beat or two.
More Worrisome Causes
The Harvard Health review also lists these more worrisome causes that can lead to more severe abnormal heart rhythms:
- A previous heart attack that affects the heart's muscle or its pacemakers
- An overactive thyroid, which can cause heart palpitations
- Too much of a prescription medicine, such as digoxin, thyroid replacement hormone, diet pills, or asthma medications, which can affect heart rate
- Abuse of illicit drugs, including stimulants such as cocaine and amphetamines
- Use of over-the-counter medicines such as those for colds or cough, dietary supplements such as ephedra, and a variety of other alternative medicines for various ailments such as ginseng and valerian root.
Untreated high blood pressure can also be a cause.
Symptoms When the Heart Skips Beats
People use various terms to describe the symptoms when they skip heartbeats. These include the feeling of:
- Flutters in the chest
- Their heart turning over
- Having to catch a breath
- A pounding, throbbing, or racing heart
These symptoms are usually of little concern when they are brief and happen only occasionally.
Symptoms of Concern
Symptoms of heart palpitations and skipped beats are more worrisome if they recur frequently. The American Heart Association reference cited above in the first section also notes you have cause for concern if the symptoms are prolonged or you have:
- Chest pain or chest pounding
- Dizziness or lightheadedness
- Fainting or feeling of almost fainting
- Shortness of breath
In severe cases, the heart can stop.
What to Do
Consult your doctor if you have any of the worrisome conditions mentioned above and your heart recurrently skips beats. Pay attention to the following, which can help your doctor figure out the cause:
- How often you have palpitations or feel like your heart skipped a beat
- How you feel when this occurs
- Your activity at the time
- If your heart rate is faster or slower than normal
It is more urgent to go to a hospital if you have any of the additional symptoms described above in the previous section. An irregular heartbeat can turn into a chaotic rhythm that puts you at increased risk for a heart attack or a stroke.
Evaluation and Treatment
Treatment of palpitations which cause your heart to skip beats will depend on your review medical history, any underlying triggers, your physical exam findings, and any testing recommended by your doctor. Effective options for therapy include:
- Relaxation techniques you can learn and use if stress, anxiety, or other emotional episodes are triggers for your irregular heart rhythm; techniques include meditation, deep breathing, and yoga
- Specific prevention or treatment of any of the underlying causes addressed above, such as anemia, drugs, and thyroid disease
- Drugs that relax the heart muscle such as beta blockers
- Ablation, or destruction, of the pacemakers or any areas of the heart that is suspected to be the cause of palpitations and skipped beats
Decrease Your Risk
Occasional, fleeting skipped heart beats are usually no cause for worry, especially if you have no symptoms of concern. If the problem is ongoing, consult your doctor so you can address any causes that might get worse and put your life at risk.