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Heart Skipping Beats

Dear Dr. Dave and Dr. Dee,

Over the past two or three days I've noticed my heart seems to skip a beat every once in awhile, and sometimes several times in a minute. I get this "flip flop" feeling inside my chest. It only lasts for a second and then everything's fine until it does it again. It mainly happens in the evening when I'm at home and it's quiet. I haven't noticed it so much at work when I'm active. I don't have any chest pain and otherwise I feel fine. But this thing's like water torture, or a case of the hiccups that won't go away. It's driving me nuts.


End of my rope

Dear End,

I was waiting for you to mention that you have been to your doctor about this. If you haven't, then you need to. Obviously anyone who has a question about their heart deserves a careful hands on evaluation by a physician. Call your doc, or if you feel you have an emergency call 911.

That understood, for educational purposes, the description is a reasonably common one. Most people who complain of a fleeting intermittent flip flop sensation in the middle of the chest, with no other associated symptoms, are describing early or "premature" heart beats. These are heartbeats that follow too soon on the heels of the preceding beat.

Our normal heartbeat is regularly paced, which enables the heart to fully fill and fully eject its contents with each beat. If a beat follows too soon the heart only has time to partially fill, which means it ejects a smaller volume of blood with that beat. The early beat, and the slight pause until the next beat, is felt as a brief flip flop feeling in the chest, without any pain, shortness of breath or other symptoms.

Most early beats are PAC's (premature atrial ontractions), or PVC's (premature ventricular contractions), depending on the origin within the heart of the early beat.

The causes can be as simple as too much caffeine, anxiety and stress, cold and allergy medicines and decongestants, or more complicated and serious, having to do with medication interactions, thyroid problems, organic heart disease, and other medical conditions. A history, physical exam, electrocardiogram and laboratory tests are required to properly investigate irregular heartbeats.