Q: I have occasional skipped beats. It feels like my heart jumps when it happens. I exercise regularly and consider myself healthy. Does this mean I have a heart problem?
A: Occasionally feeling your heart beat and having it skip is very common. It can be uncomfortable and cause worry that it may be something serious. But most of the time heart palpitations don’t signal a heart problem.
A normal heartbeat occurs when an electrical signal begins in the right upper chamber (right atrium) of the heart. As the current travels through the atria, it triggers the contraction of both upper chambers, pumping blood into the lower chambers (the ventricles). As the electrical signal spreads through the ventricles, they then contract, sending bloo,d into the lungs and body.
Here’s how I help my patients think about the symptom. I first ask about how often the palpitations occur and whether there are additional associated symptoms.
Occasional palpitations that last only a second or two typically are not anything to worry about. But if symptoms last longer and you are lightheaded, feel like you might pass out, or have chest pain or shortness of breath, you should seek immediate medical attention.
If I were seeing you in the office, I would ask you to tap the back of my hand with your fingers to simulate what the palpitations feel like. If you tap out a string of steady beats with a quick stutter for one or two seconds, and then back to steady, that almost always represents what doctors call premature beats.
Premature beats can arise either from the upper heart chambers (atria) or the lower chambers (ventricles). Usually the ones you can feel come from the ventricles. Doctors call them premature ventricular contractions, or PVCs. By themselves, they are not dangerous and usually don’t require treatment. Based on your description, that is likely what you have.
PVCs occur when an extra electrical signal starts in the ventricles soon after the previous normal contraction, triggering a second contraction. You may not feel the second contraction; instead, it may seem as though your heart has missed a beat. The next regular contraction can pump with more force than normal and you may feel a thump or the sensation that your heart has flip-flopped.
If on the other hand you were to tap out a very slow or very fast rhythm or one that is very irregular, then I would be more concerned about a different cause. Again most often these are not dangerous problems either, but they would require more investigation. That starts with listening to your heart and doing an electrocardiogram (ECG).
(Howard LeWine, M.D. is an internist at Brigham and Women’s Hospital in Boston and assistant professor at Harvard Medical School. For additional consumer health information, please visit www.health.harvard.edu.)
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