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Originally published December 22, 2022
Last updated August 7, 2024
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Your heart may pound when you’re excited. It might race when you are scared. It might flutter when you fall in love. These odd sensations are called heart palpitations. Heart palpitations may feel like your heart is skipping a beat, quivering or pounding for no reason.
“Usually when you experience a skipped heartbeat, it may be an interruption of your regular heart rhythm,” says Andrew Zadeh, MD, a cardiologist at Keck Medicine of USC. You don’t usually notice this regular rhythm when your heart is beating normally.
“Each heartbeat is transmitted to the rest of the body as a pulse,” says Dr. Zadeh, a clinical assistant professor of medicine at Keck School of Medicine of USC. “A pulse is a force exerted by the internal pressure increase in your artery as blood leaves the heart.”
When the regular heart rhythm is disrupted with an extra beat, though, the force pumping blood from the heart isn’t timed properly and isn’t as strong.
“This results in a reduced pressure increase and reduced, or sometimes unnoticeable, pulse associated with the extra beat,” Dr. Zadeh says. “When I hear patients say they feel their heart ‘skipping a beat,’ it is usually tied to a single premature beat that fails to produce an extra pulse. The ‘skip’ is the ‘pulseless’ time it takes for the next beat or pulse to come in.”
Basically, your heart’s rhythm is off, and you can notice it. Most heart palpitations are not serious medical issues. They’re just caused by fluctuations in emotion or exertion level. Let’s examine some of the reasons you may be feeling a skipped heartbeat and talk about when it might be time to see a doctor.
Although heart palpitations can sometimes be a sign of heart disease, they more frequently have non-heart-related causes. For example, when you’re nervous or excited, you might feel a fluttering or pounding heartbeat. Mental health issues, such as anxiety or stress, can cause your heart to beat strangely. And in a vicious cycle, having palpitations can also lead to more stress.
You can take steps at home to reduce stress and anxiety to help stop the feeling of a skipped heartbeat. Breathing exercises and other relaxation techniques may help, such as yoga, meditation or tai chi.
What you put in your body also can cause heart palpitations.
“Many of the patients I see who experience arrhythmia, or skipped heartbeats, can have triggers that increase the frequency of symptoms,” Dr. Zadeh says. Along with anxiety, “caffeine has traditionally been associated with an increase of symptoms for some people,” he says. “Others include alcohol, nicotine and some medications.”
Medications that may cause palpitations range from over-the-counter decongestants and diet pills to some prescription medications, including those to treat asthma. Illegal drugs, such as cocaine, can also contribute to heart arrhythmia.
“Identifying what lifestyle factors influence your symptoms is the first step, and then trying to avoid or reduce them is usually beneficial,” Dr. Zadeh says.
Many of the patients I see who experience arrhythmia, or skipped heartbeats, can have triggers that increase the frequency of symptoms. Andrew Zadeh, MD, a cardiologist at Keck Medicine of USC
Many of the patients I see who experience arrhythmia, or skipped heartbeats, can have triggers that increase the frequency of symptoms.
An arrhythmia, or a problem with how your heart beats, can cause you to feel like your heart is skipping or fluttering. The most common medical cause of arrhythmia is atrial fibrillation, also known as A-fib, which is also the most common cardiac cause of heart palpitations. In this condition, the chambers of your heart aren’t properly coordinated, which causes your heart to beat irregularly and fast.
Older adults and people with high blood pressure, obesity, diabetes or other health problems are more likely to develop A-fib. It’s important to treat the condition with medication and lifestyle changes, because it can put you at greater risk for stroke. Other atrial fibrillation symptoms to look for include lightheadedness, fatigue, shortness of breath and chest pain.
Heart palpitations can also be caused by various forms of heart disease involving the heart’s valves, muscles or arteries. For example, mitral valve prolapse is the most common structural heart problem to cause palpitations. Issues with the heart’s muscle (cardiomyopathy) and coronary heart disease (narrowing of the arteries) can also lead to arrhythmias, causing heart palpitations.
“Heart disease involving either poor blood flow or valve abnormalities can easily be evaluated through a series of tests including electrocardiogram, echocardiogram or stress testing,” Dr. Zadeh says.
Too much thyroid hormone can increase your metabolism, making your heart race and causing palpitations. Luckily, it is relatively easy to diagnose an overactive thyroid, which is a condition known as hyperthyroidism.
“Thyroid disease can be evaluated with simple blood tests,” Dr. Zadeh says. Medications are available to treat hyperthyroidism.
Although frequent heart palpitations may not be serious, it’s important to be evaluated by a doctor to make sure you don’t have a condition causing an irregular heartbeat. “This evaluation is best done by a cardiologist, who can also detect some of these conditions with a careful history and physical examination,” Dr. Zadeh says.
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