extra heartbeats are premature beats that start in the atria or ventricles. They are often perceived as a hollow, loud thump or "flutter". In many people they are benign, but the assessment is not only based on how strongly they are felt.
At a glance
The main points
- The feeling of a strong thump often follows the premature pulse.
- Caffeine, alcohol, stress and lack of sleep can increase episodes.
- ECG and Holter help to identify the type and frequency.
- Having fainting, pain or shortness of breath changes the priority.
Because it looks like the heart "stops".
The premature pulse may be less noticeable and followed by a short pause. The next normal pulse is often stronger, so many describe a gap and then a thump. This does not mean that the heart has stopped.
The sensation varies considerably: some perceive nothing, while others perceive every sudden contraction. Intensity of feeling alone does not measure seriousness.
Factors that may trigger them
Lack of sleep, psychological stress, heavy caffeine or alcohol consumption, smoking, dehydration, and certain decongestants or stimulants may be associated with more episodes. Sometimes there is a thyroid disorder, anemia, or electrolyte disorder.
Identifying a potential trigger is helpful, but should not lead to arbitrarily stopping a prescription drug or excessive dietary restrictions.
How is the initial assessment done?
The doctor asks how long episodes last, how often they happen, whether they relate to exercise and what other symptoms occur. A clinical examination and ECG may provide immediate information. If extra beats do not occur during the visit, a Holter recording can show their type, frequency and any more complex episodes.
Echocardiogram is used when the structure and function of the heart needs to be evaluated. Laboratory testing is selected based on history and not as a one-size-fits-all list.
What determines their meaning?
Origin, morphology, overall frequency, occurrence in sequences, relationship to exercise, and presence of structural heart disease are more important than an isolated count. The same percentage does not necessarily mean the same to two different people.
In selected cases, very frequent ventricular ecstasy may affect heart function and require monitoring. This is not inferred from the patient's feeling but from the comprehensive assessment.
From reassuring explanation to healing
When the heart is structurally normal, the workload is low, and there are no worrisome findings, information, monitoring, and amelioration of triggers may be sufficient. If the symptoms significantly affect daily life or there are special findings, individual treatment options are considered.
Treatment is not just about "zeroing" a number. Weighs symptoms, risk, effect on heart function and possible side effects.
What to note before visiting
Record time, duration, activity, coffee or alcohol consumption and if there was dizziness, pain, shortness of breath or tendency to faint. If a smartwatch has recorded an episode, keep the record, knowing that it is not a substitute for a medical ECG.
When not to wait
Immediate medical attention
Get immediate help if the pulse persists and there is chest pain, severe shortness of breath, fainting or severe weakness. Fainting during exercise or a family history of sudden death warrants particularly careful evaluation.
Sources & further reading
The article provides general information and is not a substitute for an individualized medical evaluation.