Skipped Heartbeat (Premature Beats): Benign vs. Concerning Causes

A "skipped beat" is usually a premature atrial contraction (PAC) or premature ventricular contraction (PVC). The pause after the early beat feels like a skip; the next beat is stronger (compensatory pause).

Common Benign Triggers

• Stress, anxiety, fatigue.
• Caffeine, alcohol, nicotine.
• Electrolyte shifts (low K⁺/Mg²⁺).
• OTC decongestants, asthma inhalers.

Red Flags for Evaluation

• Frequent (>6/min or runs of ≥3).
• Associated syncope, near-syncope, chest pain, dyspnea.
• Known structural heart disease (prior MI, cardiomyopathy, valve disease).
• Family history of sudden cardiac death.

Workup

• ECG, 24–48h Holter, echocardiogram, electrolytes, TSH.
• Exercise stress test if exertion-related.

Reassurance and trigger avoidance suffice for most; beta-blockers or ablation for symptomatic/refractory cases.