Q: I sometimes get a jumping sensation in my chest that feels like my heart is skipping beats. It lasts a few minutes and then I might not have it again for weeks. Should I be concerned?
A: Occasional, brief hiccups in the heart’s normal rhythm are rarely cause for concern. But if you have any additional symptoms, such as chest discomfort, dizziness or breathlessness, you should seek medical attention.
One common cause of what people perceive as a skipped beat occurs when the heart’s upper chambers (atria) squeeze a fraction of a second earlier than they should — a so-called premature atrial contraction. The atria then pause an instant longer afterward to get back into a normal rhythm. The heart’s lower chambers (ventricles) then contract forcefully as they clear out the extra blood that accumulates during the pause. The pause feels as though the heart has skipped a beat.
The heart’s ventricles can also contract earlier than usual, something known as a premature ventricular contraction. These may feel as though the heart has briefly stopped and restarted, causing a pounding or flip-flopping sensation.
But sometimes, fleeting abnormal heart rhythms (arrhythmias) need to be checked out. A fluttering sensation in the chest may suggest an unusually fast heart rate. If this happens with no explanation (such as exercise or anxiety), an electrical misfire in the upper part of the heart may be to blame. The most common is atrial fibrillation, a rapid, irregular heartbeat that can increase the risk of a stroke. In some people, the first symptom of atrial fibrillation is an uncomfortable awareness of an irregular heartbeat.
Another, less common arrhythmia is known as supraventricular tachycardia, or SVT. This can cause a very fast heart rate, in bouts that last for minutes but sometimes hours. Most of the time, SVT is not dangerous, but it can make people feel lightheaded or dizzy, depending on how long it lasts.
Because heart misfires tend to come and go, they are rarely detected during a brief recording of the heart’s rhythm (electrocardiogram, or ECG) done in a doctor’s office. For symptoms that occur every few weeks or so, the best option is a small patch about the size of a Band-Aid that you stick on your chest. It can record the heart’s rhythm for up to two weeks. For less frequent symptoms, a person may need to wear a cardiac event monitor for 30 days to capture the episodes of abnormal activity.
A range of factors can trigger palpitations, including exercise, anxiety, and certain medical conditions and drugs. Even when palpitations don’t signal a serious condition, they can still be bothersome enough to try a low dose beta blocker, such as atenolol or metoprolol.
Howard LeWine, M.D., is an internist at Brigham and Women’s Hospital in Boston and assistant professor at Harvard Medical School. For additional consumer health information, please visit www.health.harvard.edu.