Skipped heartbeats are the feeling that the heart stopped for a moment, missed a beat and then thumped harder than usual, sometimes with a brief flutter in the chest or the throat. In most people the cause is a premature beat, a contraction that arrives a moment before the next regular beat, followed by a short pause in which the heart fills more than usual and then beats more forcefully. Premature beats occur in almost every healthy person, and most of them are never felt at all. It is worth seeing a cardiologist when the skips are frequent, go on for weeks, come with dizziness, chest pain, shortness of breath or fainting, or when there is a family history of heart disease.
What happens in the heart during a skip
The heart beats to an electrical signal that starts in a natural pacemaker in the right atrium and travels through the atria to the ventricles. Sometimes another cell, in an atrium or a ventricle, fires a signal of its own too early. The heart contracts before it has had time to fill, so that beat is weak and often goes unnoticed. It is followed by a short pause in which the system “resets”, the heart fills more than usual, and the next beat is strong and felt as a thump in the chest. That is why many people describe the sensation as a skip, even though the heart never really stopped.
Premature beats that start in the atria and premature beats that start in the ventricles feel similar from the outside, but they look different on an electrical recording, which is why capturing a skip in real time is an important part of the work-up.
What triggers skipped beats
In most people the skips increase in some periods and disappear in others, depending on factors that irritate the electrical system of the heart:
- Large amounts of caffeine, energy drinks and alcohol, especially in the evening.
- Mental stress, anxiety and periods of heavy workload.
- Lack of sleep and accumulated tiredness.
- Smoking and stimulants, including some slimming products and cold remedies.
- Fever, infection or dehydration.
- Hormonal changes, including pregnancy, the days before a period and the menopause.
- Certain medicines, including asthma inhalers and thyroid medicines. Do not stop a regular medicine without talking to your doctor.
Many people notice the skips at rest, lying in bed at night or sitting quietly, not because they are more frequent then but because there is no background noise to distract from them. That in itself is a reassuring sign.
It helps to keep a short record for a week or two: when the skip appeared, what you ate and drank beforehand, how much you slept and how you were feeling. A record like this helps identify a personal trigger, and it is also useful material for the conversation with the doctor if a work-up is needed.
When skipped beats are harmless
In a young, healthy person with no known heart disease, occasional isolated skips that disappear with exercise and come with no other symptoms are almost always considered benign. They do not mean the heart is weak and they do not raise the risk of a heart attack. In these cases reassurance, cutting down the triggers and good sleep are usually enough for the sensation to fade.
Even when the skips are harmless, some people find them very distressing, and a cycle can develop in which anxiety about the skip provokes more skips. In that situation an orderly work-up that ends with a clear answer is itself the most effective treatment.
When to see a cardiologist
There are situations in which skips justify a work-up, even when they feel “merely annoying”. It is worth booking a visit with a private cardiologist in Modi’in when:
- The skips are frequent, several times a minute or in long runs, and go on for weeks.
- They appear during physical exertion or get worse with it, instead of disappearing.
- They come with dizziness, a feeling of faintness, sudden weakness or loss of consciousness.
- There is chest pain or pressure, or shortness of breath that was not there before.
- The pulse becomes fast and irregular for minutes at a time or longer.
- There is known heart disease, long-standing high blood pressure or diabetes.
- A first-degree relative died suddenly at a young age or was diagnosed with a disease of the heart muscle.
- The skips began after a feverish illness, a change of medication or childbirth.
Fainting that occurs together with a pounding heart, or chest pain that comes with shortness of breath and sweating, are emergencies that need an immediate visit to the emergency room, not a wait for an appointment.
What the cardiologist checks
The visit begins with a detailed conversation: what the skip feels like, when it appears, how long it lasts, what provokes it, which medicines and supplements you take, and what the family medical history is. The doctor then measures blood pressure, listens to the heart and records a resting ECG. A short recording sometimes captures the premature beat itself, and in any case it shows whether the basic electrical system is normal.
Because skips tend to appear precisely when nobody is checking, the central tool in the work-up is prolonged monitoring. The doctor refers you for a Holter, a small device attached to the body that records the heart rhythm for a full day or several days, and sometimes for a monitoring patch that is worn for a week or more. You keep a diary of when you felt a skip, and the doctor compares the sensation with the recording. This shows how many premature beats occur in a day, where they come from and whether another rhythm disorder is hiding behind the sensation.
As needed, the doctor also refers you for blood tests, mainly thyroid function and electrolyte levels, and for imaging of the heart to confirm that the structure and the function of the muscle are normal. When the skips appear with exertion, an exercise stress test helps show how the heart responds to load. Which tests are needed depends on age, symptoms and the initial findings, and for many people the work-up is complete after the Holter.
How skipped beats are treated
When the work-up is normal, the main treatment is explanation and reassurance. Understanding that the heart is healthy and that the sensation is a harmless premature beat reduces the phenomenon itself in many people. Alongside this it is advisable to cut down caffeine and alcohol, regulate sleep, reduce workload and deal with stress, and to review with the doctor any medicines and supplements that may provoke skips.
When the skips are very frequent and distressing, the doctor may suggest a medicine that slows the heart rate and reduces the sensation. In a minority of cases, when the number of premature beats per day is particularly high or when they come from one clear focus and affect the function of the heart, catheter ablation of the focus that produces them can be considered. The decision is made after a full work-up and a conversation about the benefits and the risks.
When the work-up reveals a different rhythm disorder, for example atrial fibrillation, the treatment is different and is aimed at preventing complications. You can read more in our article on palpitations and a racing heart.
Why it is worth checking rather than living with it
Most skips are harmless, but that cannot be known from the sensation alone. Very frequent premature beats over years can, in rare cases, weaken the heart muscle, while other rhythm disorders that feel like a skip need treatment of their own. A short work-up gives a clear answer, makes it possible to choose the right treatment, and spares years of anxiety about a sensation that usually turns out to be benign.
At EliteMed in the Ayala 360 complex in Modi’in you can book a visit with a cardiology specialist without a referral, and the consultation can be held in English. If you are new to private care in Israel, read our guide to private specialist consultations. The information here is general and does not replace an examination and advice from a doctor.
Frequently asked questions
Are skipped heartbeats dangerous?
In most people, especially those who are young and healthy with no heart disease, skips are harmless premature beats that do not endanger the heart. A work-up is recommended when they are frequent, appear with exertion, come with dizziness, chest pain or fainting, or when there is known heart disease or a family history of sudden death.
Why do I feel the skips mainly at night?
Lying down in a quiet room there are no outside stimuli to distract you, and the pulse is slower, so the strong beat after the pause is felt clearly. The skips are not necessarily more frequent at night, they simply stand out more. When they wake you from sleep or come with other symptoms, it is worth being examined.
What is the difference between skips and atrial fibrillation?
Skips are single beats that arrive too early against a regular rhythm. In atrial fibrillation the whole rhythm becomes irregular and usually fast, for minutes, hours or longer. The difference is established on an ECG or a Holter recording, not by the sensation, which is why a recording made during symptoms matters.
Does coffee cause skipped beats?
Large amounts of caffeine increase premature beats in some people, but moderate consumption is not harmful for most healthy people. It is worth cutting down gradually and seeing whether anything changes. Energy drinks, which contain caffeine and other stimulants in large amounts, are best avoided when you have skips.
What is a Holter and how do I prepare for it?
A Holter is a small device attached to the chest with adhesive pads that records the heart rhythm continuously for a full day or several days, during your normal routine. No special preparation is needed, only to avoid creams on the chest on the day it is fitted and to keep a short diary of symptoms and activity. The doctor compares the diary with the recording.