Skipped Heartbeats (Palpitations): Causes, Lifestyle Fixes, and Red Flags

Premature ventricular contractions (PVCs) or premature atrial contractions (PACs) are perceived as “skipped” or “extra” beats. They are common and usually benign.

Common Triggers

• Caffeine, nicotine, alcohol.
• Stress, anxiety, sleep deprivation.
• Electrolyte imbalance (low K⁺, Mg²⁺).
• OTC stimulants (pseudoephedrine, phenylephrine).
• Thyroid excess (hyperthyroidism).
• Structural heart disease (cardiomyopathy, prior MI, valve disease).

Lifestyle Modifications

1. Caffeine reduction: <200 mg/day; trial elimination.
2. Alcohol moderation: ≤1 drink/day women, ≤2 men.
3. Smoking cessation.
4. Stress management: CBT, meditation, breathing exercises.
5. Sleep hygiene: 7–9 hrs; treat apnea if present.
6. Hydration & electrolytes: Balanced diet; consider Mg²⁺ supplement if deficient.
7. Regular aerobic exercise: 150 min/week moderate; improves autonomic tone.

Red Flags – Seek Evaluation

• Frequent PVCs (>10–20% burden on Holter).
• Runs of ventricular tachycardia (≥3 beats).
• Syncope, near-syncope, exertional symptoms.
• Structural heart disease known or suspected.
• Family history of sudden cardiac death.

Diagnostic Workup

1. 12-lead ECG.
2. 24–48h Holter or 14–30d event monitor.
3. Echocardiogram (LV function, structure).
4. Labs: TSH, electrolytes, CBC, ferritin.
5. Stress test if exertional symptoms.

Treatment

Most need reassurance only. If symptomatic and frequent: β-blockers, non-DHP CCB, or flecainide/propafenone (if no structural disease). Catheter ablation for refractory PVC cardiomyopathy.