Your Heart Skips a Beat

Your Heart Skips a Beat: What Does it Mean?

By Matthew A. Bernabei, M.D., F.H.R.S.

Why does my heart skip a beat? Patients frequently ask this question. The answer may be related to a disturbance in the heart’s electrical system called an arrhythmia.

Understanding Arrhythmias

Normally, electricity moves through the heart in a very regular and controlled manner, causing the heart muscle to contract and circulate blood throughout the body. This consistent process creates a clocklike quality you can often feel or hear if you’re paying careful attention.

It’s not uncommon for the electrical system to “misfire,” throw an extra beat, or even maintain an abnormal heart rhythm for a sustained period of time. These rhythm disturbances often cause a skipping sensation patients describe as jumping, fluttering, flip-flopping, palpitating, or seesawing.

People may also experience shortness of breath, lightheadedness, or chest discomfort. And sometimes there are no symptoms at all, and the condition is discovered incidentally during a physical examination or cardiac test like an EKG.

Most Common Arrhythmias

The most common arrhythmias that cause heart-skipping are pre-atrial contraction (PAC) and pre-ventricular contraction (PVC). These extra heartbeats originate in the top or bottom part of the heart and occur between two normally timed beats.

Usually, this isn’t a worrisome problem unless the symptoms are frequent and severe. Treatment may include lifestyle changes like avoiding caffeine and addressing any underlying causes.

More Serious Heart Rhythm Disorders

Sustained heart rhythm disorders like tachycardia (heart beating too fast) or bradycardia (heart beating too slow) are more concerning.

Because these problems tend to last longer (minutes, hours, or longer), they’re more likely to cause prominent and persistent symptoms like passing out. They can also affect the heart’s longterm pumping ability. More aggressive evaluation, monitoring, and treatment (medication and/or procedures like ablation, pacemakers, or defibrillators) are almost always needed.

A few conditions in this category include:

• Atrial fibrillation (AFib), the most common of the persistent arrhythmias

• Supraventricular tachycardia (SVT)

• Ventricular tachycardia (VT)

• Heart block (dropping heartbeats, rather than adding extra beats)

What You Should Do

If you feel your heart jumping or fluttering, see a healthcare 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.

Matthew A. Bernabei, MD, FHRS, is a cardiologist with The Heart Group of Lancaster General Health. Dr. Bernabei is a graduate of Temple University School of Medicine. He served residencies at the University of Virginia Health System and Lahey Clinical Medical Center, where he also completed a fellowship. Dr. Bernabei’s areas of expertise include atrial fibrillation, cardiac resynchronization therapy, pacemaker and defibrillator implants, and ventricular tachycardia.