February 17, 2021
Why does my heart skip a beat? This is a common question from patients. In some instances, the answer may be related to a disturbance in the heart's electrical system, or an arrhythmia.
Normally, electricity moves through the heart in a very regular and controlled manner. This causes the heart muscle to contract and circulate blood throughout the body. Such a consistent and regimented process yields a "clock-like" quality to the heartbeat that you can often feel or hear if you’re paying careful attention.
Unfortunately though, it’s not uncommon for the electrical system to "misfire" or to throw an extra beat, or even to maintain an abnormal heart rhythm for a sustained period of time. These rhythm disturbances often cause a "skipping" sensation in the chest that patients also commonly describe as jumping, fluttering, flip-flopping, palpitating, or see-sawing.
These rhythm disturbances can also be associated with other symptoms like shortness of breath, lightheadedness, or chest discomfort. In some cases there may be no symptoms at all, and the condition is discovered incidentally on a physical examination or on a cardiac test like a pre-operative EKG.
Pre-Atrial Contractions: A Common Diagnosis
The most common diagnoses that cause heart-skipping are pre-atrial contractions (PAC) and pre-ventricular contractions (PVC). These are extra heartbeats that originate in the top or bottom part of the heart, respectively, and come in between two normally timed beats.
Usually, they’re not a worrisome problem unless the symptoms they cause are frequent and severe. Treatment usually includes lifestyle changes, such as avoiding well-known offending agents like caffeine, along with addressing any underlying causes.
More Serious Heart Rhythm Disorders
Sustained heart rhythm disorders like tachycardia (heart beating too fast) or possibly bradycardia (heart beating too slow) are more concerning.
Because these problems tend to last for longer periods of time (often minutes, hours, or even longer), they’re more likely to cause prominent and persistent symptoms and are of greater significance to your health.
At their most serious, they can lead to rather dramatic symptoms like passing out, and can even affect the heart's longer term pumping ability. These problems almost always warrant more aggressive evaluation, monitoring and treatment.
A few diagnoses you may have heard of fit into this category: atrial fibrillation, the most common of the persistent arrhythmias; SVT (supraventricular tachycardia); VT (ventricular tachycardia); and heart block (i.e., dropping heart-beats, as opposed to adding extra beats).
These problems are dealt with in a variety of ways, and often medication and/or procedures (like ablation, pacemakers, or defibrillators) are necessary.
What You Should Do
If you feel your heart jumping or fluttering, see a health-care provider. It’s important to differentiate among the many possible causes, as each has different implications and is managed differently.
Your doctor will often refer you to a cardiologist and, in many cases, to an electrophysiologist—a cardiologist who has special training and expertise in heart rhythm management.