Skipped heartbeats are usually premature beats: an early beat from the upper chambers (PAC) or lower chambers (PVC), followed by a pause that feels like a skip or thump. Common triggers include caffeine, alcohol, stress, poor sleep and low potassium or magnesium. They are often harmless, but frequent skips, or skips with dizziness, fainting or chest pain, need a cardiology check.
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Board-certified cardiologist · Katy & Sugar Land, TX
Fellowship-trained in cardiovascular disease, interventional cardiology, echocardiography and advanced heart failure and transplant cardiology. Former Assistant Professor of Cardiology at McGovern Medical School.
What does a skipped heartbeat mean?
Your heart does not actually skip a beat. Instead, an extra beat fires early, before the heart has fully filled. That early beat may be too weak to feel. The heart then pauses briefly to reset, and the next beat is stronger than usual because the heart has extra time to fill. Most people feel the pause as a “skip” and the strong beat as a “thump” or “flip-flop”.
- Premature atrial contractions (PACs) start in the upper chambers.
- Premature ventricular contractions (PVCs) start in the lower chambers. Learn more about PVCs and premature heartbeats.
What causes skipped heartbeats?
Premature beats happen in most people at some point, often unnoticed. Common triggers include:
- Caffeine, energy drinks, nicotine and alcohol.
- Stress, anxiety and lack of sleep.
- Dehydration and low potassium or magnesium, sometimes from water pills, vomiting or diarrhea.
- Decongestants, some asthma medicines and stimulants.
- Thyroid disease and anemia.
- Heavy meals, reflux or lying on the left side (which makes beats easier to notice).
Less often, frequent premature beats reflect underlying heart disease such as high blood pressure with a thickened heart, coronary disease, valve problems, cardiomyopathy or heart failure.
When are skipped heartbeats harmless?
Occasional PACs and PVCs in someone with a structurally normal heart are usually benign. Evaluation is recommended when:
| Usually reassuring | Needs evaluation |
|---|---|
| Occasional skips, especially with caffeine, stress or poor sleep | Skips that are frequent, in runs, or daily for weeks |
| No other symptoms | Dizziness, fainting, chest pain or shortness of breath |
| Normal heart on prior testing | Known heart disease, prior heart attack or weak heart muscle |
| Skips fade with exercise | Skips increase with exercise |
| No family history of sudden cardiac death | Family history of sudden death or inherited heart conditions |
Very frequent PVCs, often defined as more than about 10 percent of all heartbeats, can over time weaken the heart muscle in some people, which is why a monitor that counts them is useful.
- Fainting or nearly fainting
- Chest pain or pressure
- Severe shortness of breath
- A sustained fast or irregular heartbeat that does not settle
Skipped beats vs. atrial fibrillation
Premature beats feel like an occasional skip in an otherwise regular rhythm. Atrial fibrillation feels like a chaotic, irregular and often fast heartbeat that persists for minutes, hours or longer. Smartwatches can flag possible AFib but may also misread frequent premature beats, so a medical-grade recording is important.
How doctors evaluate skipped heartbeats
- EKG in the office, which may catch premature beats if they are frequent.
- Holter monitor for 24 to 48 hours to count beats and measure the PVC burden.
- Event monitor or mobile telemetry for less frequent symptoms.
- Echocardiogram to make sure the heart’s structure and pumping are normal.
- Blood tests for electrolytes, thyroid and blood count.
- Exercise stress test if skips change with activity.
How to stop skipped heartbeats
For benign premature beats, the first steps are lifestyle changes: cut back on caffeine, energy drinks and alcohol, avoid nicotine, improve sleep, manage stress and stay hydrated. If symptoms remain bothersome or the PVC burden is high, a cardiologist may recommend medicines such as beta blockers, or refer for catheter ablation in selected cases. Treating underlying conditions such as high blood pressure or thyroid disease also helps.
Palpitation evaluation in Katy and Sugar Land
If skipped beats are frequent or worrying you, Advanced Cardiology can find out what kind they are and whether your heart is otherwise healthy. Dr. Khalid sees patients at our Katy and Sugar Land offices, with EKG and echocardiogram testing in the office and Holter or event monitoring available. See our palpitations and irregular heartbeat treatment page.
Katy office: 410 W Grand Pkwy S, Suite 4D, Katy, TX 77494
Sugar Land office: 7102 Tarrington Ave, Suite 505, Sugar Land, TX 77479
Phone: (713) 258-6111
We also see patients from Fulshear, Richmond, Rosenberg, Stafford, Missouri City and west Houston.
Frequent skipped beats? Get them counted
A short heart monitor can tell you how many premature beats you have and whether they matter. Request a visit in Katy or Sugar Land.
Having symptoms right now? Call 911. Do not wait for an appointment.
Frequently asked questions
What causes skipped heartbeats?
Usually premature beats triggered by caffeine, alcohol, nicotine, stress, poor sleep, dehydration or low potassium or magnesium. Less often they reflect underlying heart disease.
Are skipped heartbeats dangerous?
Occasional skips in a healthy heart are usually harmless. Frequent skips, skips with dizziness, fainting or chest pain, or skips in someone with heart disease need evaluation.
Why do I feel my heart skip a beat when lying down?
Lying down, especially on the left side, brings the heart closer to the chest wall and makes normal premature beats easier to notice. It is often a sign of awareness rather than a new problem.
Can anxiety cause skipped heartbeats?
Yes. Stress hormones make premature beats more likely, and anxiety makes people more aware of them.
How many PVCs are too many?
There is no single cutoff, but a PVC burden above roughly 10 percent of all beats on a Holter monitor is often considered high enough to watch heart function closely.
What is the difference between PACs and PVCs?
PACs start in the upper chambers and PVCs in the lower chambers. Both feel like skips. PVCs are more relevant when frequent or when heart disease is present.
How can I stop skipped heartbeats?
Reduce caffeine, alcohol and nicotine, sleep well, manage stress and stay hydrated. If skips remain bothersome, a cardiologist may suggest medication or other treatment.
Trusted health resources
- Arrhythmia, MedlinePlus, U.S. National Library of Medicine
- Arrhythmias, National Heart, Lung, and Blood Institute (NIH)
- Anxiety, MedlinePlus, U.S. National Library of Medicine
Medical disclaimer: This article is for general education and is not a diagnosis or a substitute for care from your own doctor. If you think you may be having a heart attack, stroke or another emergency, call 911 right away.
