Extra Heartbeats: Should You Be Worried?

Do you ever get the feeling that your heart has skipped a beat? Or that it’s fluttering around in your chest?

It could mean you’re in love. But it’s more likely that you’re experiencing extra heartbeats.

The broad name for the condition causing those extra beats is ectopic heartbeats. You could be experiencing either premature ventricular contractions (PVCs) or premature atrial contractions (PACs), depending on your personal situation. While it may feel like your heart’s missing beats, the opposite is true: Your heart is actually beating more than usual.

“PVCs and PACs are irregular cardiac rhythms in which a normal beat is followed by a premature beat, either from the top chamber of the heart (PACs) or the lower chamber of the heart (PVCs),” says cardiologist Leslie Cho, MD.

In addition to extra beats, PVCs and PACs, you may also hear people describe the sensation you’re experiencing as “heart palpitations.” They’re not wrong: PACs and PVCs are examples of heart palpitations. But keep in mind that not all heart palpitations are PACs and PVCs. Sort of like geometry class: All squares are rectangles, but not all rectangles are squares.

PVCs are very common: Up to 75% of people get them. And PACs are very common in adults, but rarely happen to children who don’t have underlying heart issues.

Why do we get extra heartbeats, and should we be worried when we feel them? Is there anything we can do to prevent them? Dr. Cho gives us a PVC/PAC primer.

Should you be concerned about extra heartbeats?

PVCs and PACs may feel a bit odd, but they’re rarely a cause for concern — provided you’re otherwise healthy. That said, when it comes to your ticker, it’s always best to be sure.

If you’re experiencing frequent pounding, fluttering, skipping or flip-flopping sensations in your chest, let a provider know. You should also let them know about any other symptoms you’re experiencing, especially shortness of breath.

Your primary care provider can perform an electrocardiogram (ECG) in their office. Chances are good that they’ll also refer you to a cardiologist for a couple of specialized tests.

The types of testing you may get depend on your symptoms and physical examination.

You may receive an echocardiogram, an ultrasound of your heart and/or an exercise stress test. You’ve probably seen that last test on TV — it’s the one where a person jogs on a treadmill while wearing a bunch of heart monitors. The test helps your provider figure out how your heart behaves under stress, hence the name.

If an exercise stress test isn’t something you’re able to do, your doctor can perform a chemical stress test instead. A chemical stress test uses a medication called adenosine to mimic the impact exercise has on your heart.

Another test you’re likely to undergo is called an ambulatory electrocardiogram. It’s basically an extended ECG. All you have to do is wear a cardiac device called a Holter monitor underneath your clothes and go about your day (or days). Your cardiologist will then review the data to see what kind — and how many — palpitations you experience while going about your normal routine.

“We do not treat this condition unless you are very symptomatic,” Dr. Cho notes, “or if you have so many extra beats that it’s impacting your heart’s pumping function.”

So, how many extra heartbeats are too many? Dr. Cho says treatment becomes a conversation when more than 10% of your heartbeats are premature.

What causes extra heartbeats?

Palpitations can happen for a wide variety of reasons. Some of the causes (like caffeine) are manageable, while others (like hormonal changes) aren’t.

“Some women and people assigned female at birth (AFAB) experience extra heartbeats when they go through pregnancy or menopause,” Dr. Cho shares. “People with this condition will report a skipping, flip-flopping or fluttering in the chest. It’s confusing because the sensation comes on when they’re not physically active.”

According to Dr. Cho, a few things that can make the condition worse are caffeine, dehydration, alcohol — because it makes you dehydrated — and over-the-counter decongestants. Anxiety and stress can also bring on PVCs or PACs.

Extra heartbeats can indicate a cardiac issue, but usually not in isolation. If you have a condition like valve disease, cardiomyopathy or congestive heart failure, there will usually be other, more obvious symptoms.

When an irregular heart rhythm is an emergency

Everybody experiences extra heartbeats from time to time, often without noticing it. And, as Dr. Cho explained, PVCs and PACs aren’t concerning on their own. But that doesn’t mean you shouldn’t be vigilant.

PVCs and PACs become concerning if you start having other cardiac symptoms, too. You should seek immediate help if:

• Your heart is beating more than 100 times a minute (tachycardia).
• Your heart is beating fewer than 60 times a minute (bradycardia).
• You’re experiencing shortness of breath (dyspnea).
• You passed out (syncope) or lost consciousness, even if only briefly.
• You have pain or a feeling of pressure in your chest.
• You’re sweating, or clammy, or suddenly feel chilly for no apparent reason.
• You’re confused, lightheaded or dizzy.
• You feel extremely weak.
• You have sudden pain in your belly, arm, shoulder neck, jaw or teeth.

The beat goes on…

The medical name for an extra heartbeat depends on which chamber of the heart it happens in. Premature ventricular contractions, PVCs (the bottom chambers of the heart), and premature atrial contractions, PACs (the upper chambers), are very common in adults and can happen for many different reasons. Again, they’re common side effects of — among other things — hormonal changes, dehydration and over-consumption of caffeine or alcohol.

In most cases, PVCs and PACs are harmless. And if they cause symptoms at all (they frequently don’t), it’s usually a fluttering, flip-flopping or skipping sensation in the chest that may feel strange but doesn’t hurt.

It’s still important to let your doctor know if you’re experiencing symptoms because, in certain instances, it can mean heart disease that should be diagnosed and treated.