Heart Palpitations: Causes and When to Seek Help

Issues with skipped heartbeats?

Hello Doctor, six months ago I went to the hospital for an echocardiogram and blood tests, and everything seemed fine with my heart.
However, recently I have been experiencing intermittent skipped beats or occasional extra beats, especially during certain times or emotional moments.
These episodes of skipped or extra beats have been quite frequent over the past few hours.
Sometimes it feels better for a while, but then it returns either after a few hours or the next day.
This has been happening for three consecutive days.
I consulted my primary physician, who only reviewed the echocardiogram from six months ago, checked my finger pulse oximetry and heart rhythm, and said my heart was beating strongly and there were no significant issues.
However, at that moment, I wasn't experiencing any skipped beats.
He concluded that it wasn't a heart-related issue.
The next afternoon, I experienced skipped beats again, so I went to a nearby clinic for an electrocardiogram.
The doctor noted the skipped beats but said my heart rhythm was normal, which was similar to what my primary physician had said.
However, it still feels like the episodes are just sporadic in nature.
I would like to ask you, if the measurements are taken when there are no skipped or extra beats, can we still confirm whether there is a heart problem? Also, based on what I have described, do you think I have any issues? What are your thoughts?

Chen, 30~39 year old female. Ask Date: 2022/01/21

Dr. He Dongjin reply Cardiology

Hello, the missed beats are likely benign arrhythmias with no life-threatening risk.
Since you have undergone echocardiography and there are no significant issues with your heart, there is no need to worry too much.
You should be fine.
Changhua Hospital cares about you.

Reply Date: 2022/01/21

More Info

Understanding heart palpitations can be quite concerning, especially when they manifest as irregular heartbeats or sensations of skipped beats. Based on your description, it seems you have been experiencing episodes of palpitations, where your heart feels like it is beating too hard, too fast, or skipping beats. You have also mentioned that you have had a thorough evaluation six months ago, including echocardiograms and blood tests, which indicated no significant heart issues at that time.

Palpitations can arise from a variety of causes, and understanding these can help you determine when to seek further medical attention. Common causes of palpitations include:
1. Emotional Stress and Anxiety: Stressful situations or anxiety can trigger the release of adrenaline, which may lead to an increased heart rate or palpitations. Given that you mentioned experiencing emotional fluctuations, this could be a contributing factor.

2. Caffeine and Stimulants: Consumption of caffeine (found in coffee, tea, energy drinks) or other stimulants can lead to palpitations. If you consume these substances, consider reducing your intake to see if your symptoms improve.

3. Physical Activity: Engaging in vigorous exercise can also cause palpitations, especially if your body is not accustomed to the intensity. It’s important to listen to your body and avoid overexertion.

4. Hormonal Changes: Fluctuations in hormones, such as during menstruation or menopause, can also lead to palpitations in some individuals.

5. Medical Conditions: Conditions such as hyperthyroidism, anemia, or electrolyte imbalances can cause palpitations. You mentioned having low hemoglobin levels (anemia), which could potentially contribute to your symptoms, as anemia can lead to an increased heart rate as your body tries to compensate for reduced oxygen delivery.

6. Cardiac Conditions: While less common in younger individuals without a history of heart disease, structural heart issues or arrhythmias can also cause palpitations. Your previous tests have ruled out significant heart disease, but it’s important to remain vigilant.

Regarding your concern about whether a normal heart rhythm can be confirmed if palpitations are not present during the examination, it is indeed possible. Heart rhythms can be intermittent, and if the palpitations occur sporadically, they may not be captured during a brief examination. This is why some doctors may recommend a Holter monitor, which records your heart’s activity over 24-48 hours, or an event monitor that you can activate when you feel symptoms. This can provide a more comprehensive view of your heart's rhythm and help identify any underlying issues.

Given that your symptoms have persisted and are causing you concern, it would be prudent to follow up with your healthcare provider. You might want to discuss the possibility of further monitoring or testing, especially if your symptoms are affecting your quality of life. Keeping a diary of your palpitations, noting the timing, duration, associated activities, and any other symptoms, can be helpful for your doctor in understanding your condition better.

In conclusion, while your previous evaluations suggest that there is no significant heart disease, the persistence of your symptoms warrants further investigation. It’s essential to communicate openly with your healthcare provider about your experiences and concerns so that you can work together to find the best approach to manage your symptoms. Remember, your health and peace of mind are paramount, and seeking help when needed is always the right choice.

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