Skipped Heartbeats: Premature Beats and Extrasystoles
"My heart seems to stop briefly and then start again." "I suddenly feel a strong thump in my chest." "Sometimes I feel a beat in my throat or a gap in my heartbeat."
Premature beats, also called extrasystoles, are one possible cause of these sensations. However, not every palpitation is a premature beat: a recording of the rhythm is needed to distinguish the cause.
What is a premature beat?
A premature beat occurs when an electrical impulse arises before the next normal beat is due. Beats originating in the atria are called premature atrial contractions (PACs); those originating in the ventricles are premature ventricular contractions (PVCs).
A brief pause afterwards and the stronger normal beat that follows can feel like a skipped or forceful heartbeat. The sensation does not mean that the heart has actually stopped.
What symptoms can occur?
- Skipping, fluttering or an extra beat.
- A sudden thump in the chest or throat.
- A brief feeling of irregularity.
- With frequent beats, fatigue, breathlessness or dizziness.
Some people notice nothing. Symptom intensity does not reliably indicate the number or danger of premature beats. A few beats can be very uncomfortable, while frequent beats may be unnoticed.
What should you tell your doctor?
Describe when symptoms started, how often they occur, whether they are single thumps or prolonged rapid episodes, and whether they occur at rest or during exercise. Report fainting, chest pain, known heart disease, a family history of unexplained early sudden death, and all medicines, supplements and stimulants you use.
Noting symptom times can help match the sensation to an ambulatory rhythm recording.
How are premature beats diagnosed?
An ECG can identify a premature beat if it occurs during recording. A short normal ECG does not exclude intermittent ectopy. Holter or longer monitoring measures frequency, percentage of total beats and accompanying arrhythmias, and helps correlate symptoms.
Echocardiography evaluates the heart muscle, valves and pumping function. Blood tests may assess thyroid function and electrolytes. Exercise testing may clarify the relationship with exertion. Cardiac MRI is reserved for selected findings and is not necessary for everyone.
Are they dangerous?
Occasional isolated beats in a structurally normal heart are often benign. Nevertheless, it is not correct to assume that every premature beat is harmless. Underlying disease, rhythm characteristics and frequency all matter. Very frequent PVCs can impair ventricular function in some patients, even without major symptoms.
What can trigger them?
Poor sleep, stress, nicotine, alcohol, excess caffeine, energy drinks and certain stimulating medicines may contribute. Thyroid disorders, electrolyte disturbances and sleep apnoea may need assessment. A clear trigger is not always found.
Coffee is not automatically forbidden for everyone. Responses vary. If there is a consistent relationship between caffeine and symptoms, reducing intake and observing the effect can be useful.
Can you exercise?
Premature beats do not automatically mean you should stop all exercise. When assessment finds no important heart disease or high-risk rhythm features, regular activity is often encouraged.
Palpitations that begin or worsen during exercise need assessment, particularly with dizziness, fainting or chest pain. Intense exercise may need to pause until evaluation is complete. Suppression of premature beats during exercise alone does not prove they are safe.
What treatments are available?
Low-risk patients with few symptoms may need observation and lifestyle measures only. Appropriate medication, such as a beta blocker, may help troublesome symptoms. Selection depends on the rhythm, blood pressure, heart rate and underlying disease.
Catheter ablation identifies and treats the focus responsible for the beats. It may be considered for frequent symptomatic PVCs or when ventricular function is affected, and can be an initial option for some PVC types. Success and risks depend on the focus.
Daily life and warning signs
Maintain regular sleep, avoid nicotine and energy drinks, reduce alcohol and assess individual caffeine sensitivity. Do not start rhythm medicines or potassium/magnesium supplements without advice. Follow the recommended monitoring plan.
Palpitations with fainting, ongoing chest pain, severe breathlessness or serious weakness require urgent assessment. Do not assume these are simply your usual premature beats. Call 112.
Assoc. Prof. Sezen Bağlan Uzunget, MD — Cardiologist
This information is educational. Individual evaluation is needed for diagnosis and treatment.
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