Premature heartbeats often feel like a skipped beat, a sudden thump, a brief flutter, or an extra beat in your chest. Some people notice a pause followed by a stronger heartbeat, while others feel nothing at all. These sensations can occur at rest or during activity. Occasional premature beats are common, but frequent or worsening symptoms deserve medical attention, especially when accompanied by chest pain, breathlessness, or fainting.
What does a premature heartbeat feel like?
A premature heartbeat is an extra heartbeat that occurs earlier than expected. It can briefly interrupt your heart's usual rhythm, creating an unusual sensation in your chest. The feeling may last only a moment, and you might notice a single unusual beat rather than a continuous change in your heartbeat.
According to the American Heart Association, the sensation often described as a skipped beat may actually be an early heartbeat followed by a pause and a more forceful normal beat.
People may describe the sensation in different ways, including:
- A skipped beat: It may feel as though your heart briefly stops or misses a beat.
- A sudden thump: One heartbeat may feel noticeably stronger than the beats around it.
- A flutter or flip-flop: You may notice a brief, irregular movement or fluttering feeling in your chest.
- An extra beat: Your heart may seem to beat twice quickly or produce an unexpected additional beat.
- A pause followed by a strong beat: You may notice a short gap in the rhythm, followed by a pronounced thump.
Not everyone experiences these sensations. Some premature heartbeats occur without any noticeable symptoms and are discovered during a routine examination or heart rhythm test.
Why can an extra heartbeat feel like a skipped beat?
Your heart normally beats in a coordinated rhythm. A premature heartbeat occurs when an electrical signal triggers a contraction earlier than expected. Because this early beat may pump less blood than a typical beat, it can be difficult to feel. A brief pause may follow, and the next regular heartbeat can feel stronger than usual.
This sequence explains why a person may perceive a pause or a forceful thump rather than the early beat itself. The sensation can be startling, particularly when it occurs unexpectedly, but the feeling alone does not establish whether the underlying rhythm is harmless or needs treatment.
Where in the heart do premature beats start?
Premature beats are commonly grouped into two types, based on where the early electrical signal begins:
- Premature atrial contractions (PACs): These begin in the atria, the heart's upper chambers. They may feel like an extra beat, a skipped beat, or a brief flutter.
- Premature ventricular contractions (PVCs): These begin in the ventricles, the heart's lower chambers. They may cause a noticeable thump, a fluttering sensation, or the feeling that the heart has skipped a beat.
The Cleveland Clinic explains that premature atrial contractions may be felt as pounding, skipped, or irregular beats, although some people have no symptoms. The sensation alone cannot reliably distinguish a PAC from a PVC or another heart rhythm problem.
When are premature heartbeats most noticeable?
Premature beats can occur during everyday activities, while exercising, or when resting. Some people become more aware of them when sitting quietly or lying down because there are fewer distractions. Others notice them during periods of stress or after consuming caffeinated drinks.
The timing and pattern may be useful information for a healthcare professional. For example, it can help to note whether the sensations happen occasionally or repeatedly, begin during activity or rest, or are becoming more frequent. However, when a heartbeat feels unusual is not enough on its own to determine its cause.
What can trigger premature heartbeats?
Premature beats may occur without an identifiable cause. In other cases, certain habits, medicines, or health conditions may contribute to them. The Mayo Clinic identifies several factors that may be associated with premature ventricular contractions, including stimulants, alcohol, some medicines, anxiety, and underlying heart disease.
- Caffeine and nicotine: These stimulants may contribute to extra heartbeats in some people.
- Alcohol: Alcohol use can be associated with premature beats.
- Stress and anxiety: Emotional stress may make extra beats more likely or more noticeable.
- Physical activity: Premature beats can occur during exercise, although the significance depends on the circumstances and the person's heart health.
- Medicines: Some medicines, including certain decongestants and antihistamines, may contribute to premature beats.
- Underlying health conditions: Heart disease and changes in blood electrolyte levels can be associated with abnormal heart rhythms.
These are possible triggers, not proof of a particular cause. If you notice a consistent relationship between an activity, drink, medicine, or situation and your symptoms, record it and discuss it with a healthcare professional. Do not stop prescribed medicines without medical advice.
Are premature heartbeats dangerous?
Occasional premature heartbeats are common and are often not a cause for concern, particularly in people without underlying heart disease. However, their significance depends on factors such as how frequently they occur, whether they are increasing, the presence of other symptoms, and the person's medical history.
The MedlinePlus Medical Encyclopedia notes that ectopic heartbeats are common and may be associated with factors such as caffeine, alcohol, smoking, certain medicines, and underlying heart conditions. Frequent or persistent episodes warrant assessment to determine whether further investigation is needed.
Do not rely only on how strong or mild a heartbeat feels. A brief sensation may have several possible explanations, and some heart rhythm problems produce few noticeable symptoms.
When should you seek medical attention?
Arrange a medical appointment if premature heartbeat sensations keep returning, become more frequent, worsen, disrupt sleep or daily activities, or are difficult to interpret. It is also important to discuss new palpitations with a healthcare professional if you have a known heart condition or a relevant family or personal medical history.
Seek emergency medical care immediately if the unusual heartbeat occurs with chest pain, significant shortness of breath, fainting, or a feeling that you are about to faint. These symptoms can indicate a potentially serious problem and should not be attributed to harmless extra beats without assessment. Use your local emergency number if urgent help is needed.
How do doctors determine whether the sensation is a premature heartbeat?
A description of the sensation is a useful starting point, but it may not identify the actual rhythm. A healthcare professional may ask when the episodes began, how often they occur, how long they last, what you were doing when they started, and whether other symptoms accompany them. They may also review your medicines, stimulant use, medical history, and any known heart conditions.
An electrocardiogram (ECG or EKG) records the heart's electrical activity and may identify premature beats if they occur during the test. If the episodes are intermittent, a wearable heart rhythm monitor may be recommended to record activity over a longer period. Depending on the history and initial findings, additional tests may be appropriate.
What should you keep track of when the sensation happens?
If you experience recurring episodes, a simple record can help you describe them clearly at an appointment. Note the approximate time, what you were doing, how long the sensation lasted, and whether you experienced dizziness, breathlessness, chest discomfort, or other symptoms. You can also record possible associations with caffeine, alcohol, stress, exercise, or changes in medication.
This information may help a healthcare professional decide whether a heart rhythm recording or other assessment is needed. Do not delay urgent medical care to keep a record if warning symptoms occur.