Reasons Your Heart Just Skipped a Beat and When to Worry

Heart palpitations are usually normal—a cardiologist weighs in on ways to tell if it’s something more serious.

woman holding chest, hands on chest, heart palpitation

Has your heart ever felt like it was fluttering, throbbing, pounding or skipping a beat? That feeling is called a heart palpitation.

Generally, heart palpitations aren’t life threatening, says Tanmay Swadia, MD, a cardiologist at Saint Joseph Mercy Health System in Livonia, Michigan. Infrequent palpitations and palpitations only lasting a few seconds usually don't need further evaluation. However, there are instances where a dysrhythmia, or an abnormal heart beat, can be a cause for concern. Dr. Swadia details ways to tell if the heart beat in your chest is normal, or not.

What your heart beat says about your heart

Palpitations are basically a heightened awareness of your own heartbeat, explains Swadia. Your heart might beat faster, slower or differently than usual for a few reasons.

  • Rapid, fast heartbeat at rest could be caused by stress, caffeine, alcohol, tobacco, thyroid pills, cold medication, asthma drugs or diet pills.
  • Sometimes low blood pressure, heart disease and some heart rhythm conditions can cause rapid heartbeat, too.
  • A slow, forceful heartbeat might be a sign of heart rhythm problems such as bradycardia, in which your heart beats less than 60 times a minute.
  • An irregular or fluttering heartbeat could be caused by atrial fibrillation (AFib), the most common type of irregular or abnormal heartbeat. Another heart problem, called premature ventricular contractions, can create this irregular beat. 

It might be difficult for patients to describe how exactly their heart is feeling. And likewise, doctors sometimes have a hard time understanding what the patient is feeling.

“I have patients describe their heart beat by tapping their finger on the table and just tell me how it feels to them,” says Swadia. This helps him take a first step towards diagnosing the problem at hand.

What’s normal and not-so-normal

The good news: While uncomfortable at first, heart palpitations are mostly benign. As far as frequency goes, heart flutters can occur frequently or infrequently, says Swadia.

“Generally, the frequency of heart palpitations does not dictate if the palpitations are serious or benign.” The symptoms that accompany the palpitations usually signal whether it’s a medical emergency or not, he adds.

You should seek immediate medical attention if you have any of the following symptoms:

  • Dizziness
  • Lightheadedness
  • Chest pain
  • Shortness of breath
  • Fainting

Palpitations can be a sign of a heart problem—this is more likely in men or people with heart disease. If your palpitations are frequent, worsening, or lasting more than five minutes, speak with your doctor about your symptoms.

Anxiety, stimulants and gender also affect your heart beat

Some groups of people are at higher risk than others. Women who are menstruating, perimenopausal or pregnant may have a higher risk of experiencing heart palpations because of hormonal changes.

Other groups at higher risk include people who:

  • Experience regular panic or anxiety attacks.
  • Take medications like thyroid pills or stimulants like caffeine and diet pills.
  • Have an existing medical condition such as an overactive thyroid or a heart condition.

What to expect during a doctor’s visit

If you go into the doctor for heart palpitations, expect your physician to do a thorough medical history and exam.

“Getting the patient’s story and performing an in-depth physical exam—including listening to the lungs, evaluating the heartbeat and the pulse—is very important in figuring out if a patient needs further evaluation,” says Swadia.

Typically doctors also use an electrocardiogram, (ECG or EKG), which assesses the electrical conduction of the heart. Even if the EKG comes back normal, it doesn’t rule out an arrhythmia or heart rhythm problem

Your doctor might recommend something called an ambulatory monitor. These include holter monitors, which are worn for 24 to 72 hours. Another device, called an event recorder, is worn for two to four weeks. The pocket size device can check for an abnormal heart rhythm when you notice symptoms.

If the underlying cause of your heart palpitation turns out to be a more serious heart condition, your doctor may do a more comprehensive evaluation.

Detect heart irregularities during your day-to-day 

Besides a visit to the doctor’s office, you can now also get notified if you have an irregular heartbeat just by looking at your wrist. Apple, in partnership with Stanford Medicine, released an Apple Heart Study app which they hope will empower people to take control of their health. 

The app uses the Apple Watch’s special technology to measure heart rate and blood flow through someone’s wrist. It will notify users if it senses an irregular heartbeat from AFib. The person can then connect directly with a physician either over the phone or on video conference to determine any next steps. Participants might be sent an EKG patch for additional monitoring, and can expect a follow-up meeting with the study coordinator.

While the app is currently available to anyone living in the US who is at least 22 years old and also owns an Apple Watch, Series 1 or newer, it’s not yet FDA approved for the diagnosis of any heart condition.

Whether you track your heart rate using an app or an EKG, it’s important to understand what can trigger a palpitation in the first place.

Simple lifestyle modifications that lower your risk

“I cannot emphasize enough how much lifestyle measures go a long way,” says Swadia.

Try to cut out any known triggers such as smoking, heavy alcohol usecaffeine and energy drinks. “A lot of young people tend to overuse some of the energy drinks, which is one of the leading causes of palpitations,” says Swadia. Pencil in some time for self-care to reduce stress levels and lower your chances of palpitations. Aim to drink six to eight glasses of water a day and get seven to nine hours of sleep a night, too.

Next time you get heart palpitations, try this

If you feel your heart pounding, use these strategies:

  • Relax: Lower your stress levels by using relaxation techniques like yoga, meditation and deep breathing. These techniques can help bring your heart rate back to normal.
  • Reach for some water: Dehydration can cause a heart palpitation, so if your heart flutters, chug some H20.
  • Workout: Exercise keeps your heart healthy and increases your heart rate, which can prevent palpitations. Try a brisk walk around your neighborhood.
  • Cough: Vagal maneuvers, such as coughing or throwing cold water on your face, can stimulate the vagus nerve which helps regulate heart rate. Talk to your doctor first before performing vagal maneuvers at home.

"While heart palpitations often cause a lot of discomfort to the patient, most of the time they aren’t dangerous," says Swadia. If you can perform those at-home tips to temporarily relieve discomfort, then you can always decide if you want to see a cardiologist. 

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