Conditions

My Heart Skips a Beat: Premature Beats and Extrasystoles

“It feels as though my heart stops for a moment and starts again.”
“I suddenly feel a strong thump in my chest.”
“Sometimes I feel a beat in my throat, or a gap in my heartbeat.”

One possible cause is premature beats, also called extrasystoles: extra beats that interrupt the normal heart rhythm. However, not all palpitations are caused by premature beats. Recording the heart rhythm is needed to tell the difference.

What is a premature beat?

The heart normally works through regular electrical signals. Sometimes a signal starts from a different area before the next normal beat is due, producing an early heartbeat.

Beats arising in the upper chambers are called premature atrial contractions (PACs), or supraventricular extrasystoles (SVES). Those arising in the lower chambers are called premature ventricular contractions (PVCs), or ventricular extrasystoles (VES).

A short pause after an early beat, followed by a stronger normal beat, may feel as though the heart has stopped or is pounding out of the chest. This sensation does not mean that the heart has actually stopped.

What symptoms can occur?

Premature beats may go unnoticed, or may cause:

• A skipped, missed or extra heartbeat.
• A sudden strong beat in the chest or throat.
• Brief irregularity or palpitations.
• Fatigue, breathlessness or dizziness, particularly when beats are frequent.

How severe the symptoms feel does not directly indicate the number of premature beats or how dangerous they are. A few beats may be very distressing, while someone with frequent beats may feel nothing. Assessment therefore involves more than how strongly the palpitations are felt.

What information is useful at your appointment?

When symptoms began, how often they occur and what brings them on can help with diagnosis. Share the following:

• Do you feel one strong beat, or a rapid heartbeat lasting several minutes?
• Do symptoms occur at rest, while walking or during sport?
• Are they accompanied by fainting, chest pain or breathlessness?
• Do you have known heart disease, or a family history of unexplained sudden death at a young age?
• Which medicines, supplements and stimulant products do you use?

Noting the time of symptoms and what you were doing can help match them to a rhythm recording.

How are premature beats diagnosed?

ECG: Records the heart’s electrical activity. If a premature beat occurs during the recording, it can indicate the type and possible site of origin. A normal short ECG does not rule out premature beats at other times of day.

Holter monitoring: A portable device records your heart rhythm during daily activities. It shows the number of premature beats, their proportion of all heartbeats, and whether other rhythm disturbances are present. Longer recording may be needed if symptoms are infrequent.

Echocardiography: An ultrasound examination of the heart that assesses the heart muscle, valves and pumping function.

Blood tests and other investigations: Thyroid function and electrolyte levels, such as potassium, may be checked when needed. An exercise test may assess the relationship with physical activity. Cardiac MRI is requested in selected patients with relevant findings; it is not necessary for everyone.

Are premature beats dangerous?

In people with normal heart structure and function, occasional isolated premature beats usually have a favourable outlook. Nevertheless, it is not correct to assume that every premature beat is harmless.

Underlying heart disease, the characteristics of the beats and their frequency all matter. Very frequent PVCs can reduce the heart’s pumping function over time in some people. Follow-up may be needed even without symptoms.

What can trigger them?

Lack of sleep, stress, nicotine, alcohol, excess caffeine, energy drinks and some stimulant medicines may increase premature beats. Thyroid disease, electrolyte imbalances and sleep apnoea are also possible contributing conditions. A clear trigger is not found in every patient.

Coffee is not forbidden for everyone. The effects of caffeine vary between individuals. One study found more PVCs on days when coffee was consumed, without a significant increase in premature atrial beats. If your symptoms are clearly linked to coffee, reducing your intake and observing the change may help.

Can I exercise?

Finding premature beats does not automatically mean that you must stop exercising. Regular physical activity is generally encouraged when assessment finds no significant heart disease or high-risk rhythm features.

However, palpitations that begin or increase during exercise need assessment, especially if accompanied by dizziness, fainting or chest pain. A pause from strenuous exercise may be necessary until investigations are complete. Premature beats becoming less frequent with exercise does not, by itself, prove that they are safe. The type and intensity of exercise should be individualised.

What treatment options are available?

Monitoring and lifestyle changes: People at low risk with few symptoms may not need medication. Regular sleep, stopping smoking, reducing triggers and treating associated conditions may be sufficient.

Medication: Beta blockers or other suitable medicines may be used for troublesome symptoms, depending on the type of premature beat and the condition of the heart. Treatment is chosen according to heart rate, blood pressure and other medical conditions.

Catheter ablation: Thin catheters are passed through blood vessels to the heart to locate and treat the area producing the premature beats. This may be considered particularly for frequent, troublesome PVCs or when pumping function is affected. For some types of PVC, it may also be a first treatment option. Success rates and risks depend on the site of origin.

What should I consider in daily life?

Keep a regular sleep routine and avoid nicotine and energy drinks. Reduce alcohol and observe whether caffeine affects your symptoms. Meet your fluid needs in line with any other medical conditions. Stress management may ease symptoms, but palpitations should not be attributed to stress without assessment.

Do not start rhythm medication or potassium or magnesium supplements without medical advice. Follow the recommended review schedule instead of attending only when symptoms worsen.

When should I seek emergency help?

If palpitations are accompanied by fainting, persistent chest pain, marked breathlessness or feeling seriously unwell, do not assume that your usual premature beats are responsible and wait. Call 112.