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Medical News Today: What causes the heart to skip a beat?

When heartbeats suddenly become more noticeable, they are called heart palpitations. Sometimes they can feel as though the heart has skipped a beat.

Palpitations can also feel like the heart is pounding, fluttering, or beating irregularly. A person may experience these sensations in the throat or the neck. They can last for a few seconds or several minutes.

Heart palpitations can be frightening, especially when experienced for the first time. However, they are usually nothing to worry about.

What is a heart palpitation?

A heart palpitation happens when someone suddenly feels one or more heartbeats. Because the heart pumps blood automatically, people are usually unaware of individual beats.

This pumping allows the blood to circulate throughout the body, delivering oxygen and other essential components. The heart has four chambers that are attached by one-way valves.

A heartbeat is a pumping action that takes about 1 second and happens in two parts:

  • Part 1: As blood collects in the upper two chambers, an electrical signal causes a contraction that pushes blood to the lower chambers.
  • Part 2: Blood is pushed from the heart into the lungs, where it is mixed with oxygen before circulating around the body.

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Causes of skipped beats

The heart skipping a beat can be the result of a number of factors, including:

1. Lifestyle triggers

Strenuous exercise, not getting enough sleep, or drinking too much caffeine or alcohol can all lead to heart palpitations.

Smoking tobacco, using illicit drugs such as cocaine, or eating rich or spicy foods can also cause the heart to skip a beat.

2. Psychological or emotional triggers

Palpitations can be caused by stress or anxiety.

They may also occur during a panic attack. Other symptoms of a panic attack include:

  • nausea
  • feeling weak or dizzy
  • numbness in the extremities
  • chest pain or tightness
  • trembling
  • shortness of breath

3. Medication

A number of medicines can trigger heart palpitations. These include:

  • asthma inhalers, such as salbutamol and ipratropium bromide
  • medications for high blood pressure, such as hydralazine and minoxidil
  • antihistamines, such as terfenadine
  • antibiotics, such as clarithromycin and erythromycin
  • antidepressants, such as citalopram and escitalopram
  • antifungal medicines, such as itraconazole

Anyone who has frequent heart palpitations and is taking medication should check the list of possible side effects on the label.

They should not stop taking the drug, however, without speaking to a doctor. Usually, heart palpitations are a harmless side effect.

4. Hormone changes

Periods, pregnancy, and menopause can all cause heart palpitations.

5. Arrhythmias

Senior man holding his chest because of heart pain
Arrhythmias are common in older people.

Arrhythmias are a group of health conditions that can interfere with the heart’s rhythm. Millions of people have arrhythmias, and they are especially common as people get older.

Most are harmless, but some require medical attention.

The following are examples of arrhythmias:

  • Atrial fibrillation, which can cause a fast, irregular heart rate.
  • Atrial flutter, which can make the heart beat quickly with a regular or irregular rhythm.
  • Supraventricular tachycardia, which causes episodes marked by an abnormally fast but regular heart rate. It tends to affect otherwise healthy people.
  • Ventricular tachycardia, a potentially serious condition that causes a fast, regular heart rhythm and is sometimes associated with dizziness or blackouts.

6. Heart conditions

In some cases, palpitations can indicate problems with the heart. Examples include:

  • A mitral value prolapse, which causes blood to flow inefficiently through the heart.
  • Heart failure, which happens when the heart is unable to pump blood effectively.
  • Hypertrophic cardiomyopathy, which refers to an enlargement of the heart muscle and its walls.
  • Congenital heart disease, which refers to abnormalities that are present from birth.

7. Other medical conditions

The following issues can also cause palpitations:

Symptoms

Heart palpitations tend to feel like a fluttering or churning in the chest or neck.

When more serious arrhythmias are responsible, palpitations can occur with the following symptoms:

  • tiredness
  • dizziness
  • lightheadedness
  • fainting
  • a rapid or pounding heartbeat
  • shortness of breath
  • chest pain

In extreme cases, heart palpitations can lead to sudden cardiac arrest.

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When to see a doctor

Patient receieving notes from doctor.
If heart palpitations continue without improvement, medical attention is required.

If heart palpitations happen occasionally and pass quickly, it is unlikely that the underlying cause is severe.

It is a good idea to speak to a doctor when palpitations:

  • follow a history of heart problems
  • last for long periods
  • do not improve over time
  • get worse

Some cases require emergency medical attention. Seek medical help immediately when palpitations accompany any of these symptoms:

  • severe shortness of breath
  • pain or tightness in the chest
  • light-headedness or dizziness
  • fainting or blacking out

Diagnosis

To investigate the cause of heart palpitations, a doctor will usually ask about a person’s symptoms and medical history.

They may also recommend blood tests and an electrocardiogram to check the heartbeat. If the doctor suspects a heart problem or an arrhythmia, they may request:

Holter monitoring

Also called a continuous ambulatory electrocardiographic monitor, a person wears a Holter monitor for 24–48 hours to record the heart’s rhythm.

Treadmill testing

Exercise or stress tests are designed to trigger a palpitation so that it can be diagnosed. A person will usually walk and run on a treadmill or ride a stationary bicycle while the heart rate and rhythm are monitored.

Echocardiogram

This test uses sound waves to create an image of the heart’s size, structure, and motions.

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Treatment

Treatment will depend on the cause of the palpitations. When lifestyle factors such as excessive alcohol or caffeine consumption are responsible, a person can take steps to avoid those triggers.

A person with palpitations caused by stress, anxiety, or panic attacks may benefit from learning breathing exercises and stress-management techniques, such as yoga and meditation. It may also be a good idea to speak with a therapist.

Most arrhythmias are harmless and do not require treatment. However, some are classified as clinically significant and require long-term medication.

A person with a diagnosed heart condition, such as heart failure, will usually be given a treatment plan that includes lifestyle changes and medication.

While not everyone with a congenital heart defect will need treatment, some may require surgery or cardiac catheterization.

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