What are ectopic heartbeats and are they dangerous?

Few heart symptoms cause as much worry as the sense that your heart has skipped a beat. It might be a thud in the chest, a brief pause, or a flutter that catches you off guard as you lie in bed. For most people the cause is an ectopic heartbeat, and in most cases it is harmless.

Ectopic beats are early or extra heartbeats. The British Heart Foundation describes them as common, with most people experiencing them at some point in their lives, and says they are usually harmless and do not damage the heart. Many people who have them never feel them at all, or have them while they are asleep.

Usually harmless is not the same as always harmless, though. Knowing the difference is what allows most people to stop worrying, and a few to get the right tests.

When to Get Help Straight Away

First, the important exceptions. The NHS advises that you call 999 or go to A&E if you have palpitations that do not go away, or palpitations together with chest pain, shortness of breath, or feeling faint or fainting. Do not drive yourself. If those symptoms have happened but have now stopped, ask your GP surgery for an urgent appointment or contact NHS 111.

What Is Happening in the Heart

Every normal heartbeat starts in a small cluster of cells called the sinus node, the heart's natural pacemaker. The signal spreads through the upper chambers and then the lower chambers in a coordinated sequence, so the heart squeezes in the right order.

An ectopic beat is one that starts somewhere else, a little earlier than the next normal beat was due. It can arise in the upper chambers, the atria, or in the lower chambers, the ventricles. Those from the lower chambers are known as ventricular ectopics, or premature ventricular contractions. Both kinds belong to the wider family of heart rhythm disorders, which is why doctors sometimes describe them as an arrhythmia, a word that sounds far more alarming than the beats usually are.

What Ectopic Beats Feel Like

The sensation varies a great deal from one person to the next. The feelings people most often describe include the following.

• A skipped or missed beat.
• A sudden thump in the chest followed by a pause.
• A fluttering sensation.
• A pounding or racing heartbeat.

The British Heart Foundation notes they can be felt in the chest, neck or throat, and can last seconds, minutes or longer. They also come in patterns. Some people have a single extra beat now and then, others have one before every normal beat for a while, or several in a row.

Many people notice them most at rest, particularly in the evening or lying in bed, when the body is quieter and there is less to distract from internal sensations. Heart palpitations of this kind are a symptom rather than a diagnosis, and whether palpitations point to a heart problem covers the wider range of causes.

Common Triggers

Ectopic beats often have an identifiable trigger, and the most common are everyday ones. The British Heart Foundation lists strenuous exercise, lack of sleep, stress, anxiety, alcohol, smoking and caffeine. Some medicines can cause them too, so it is worth checking the leaflets for anything you take, although you should not stop a prescribed medicine without speaking to your GP first.

Hormonal changes play a part as well. Ectopic beats are especially common at times such as the menopause, and the NHS notes that some people get palpitations during pregnancy.

Other medical conditions can contribute, including an overactive thyroid and iron deficiency anaemia. This is one reason a simple blood test is often part of the assessment.

If you suspect a trigger, a symptom diary kept for a couple of weeks can be revealing. Note when the beats happen, what you had been doing, and what you had eaten or drunk. The British Heart Foundation suggests keeping a symptom diary for palpitations, and cutting back on caffeine and alcohol is a sensible first step for most people. Breathing exercises, yoga and mindfulness can also help where stress and anxiety are part of the picture.

When They Are Worth Having Checked

Not every ectopic beat needs investigating. The NHS suggests seeing a GP if palpitations keep coming back or are happening more often, last longer than a few minutes, or if you have a heart condition or a family history of heart problems.

A cardiology assessment is particularly worthwhile in a few situations.

• The extra beats are very frequent, or are coming in runs of several in a row.
• You already have a heart condition, or heart problems run in your family.
• They are worrying you enough to affect your sleep, your exercise or your day to day life.

That last point matters more than it might seem. Even when ectopic beats are harmless, being constantly aware of them is unpleasant, and a clear explanation often helps people stop listening out for every beat.

How They Are Investigated

The aim is to answer two questions. Are these ectopic beats, and is the heart otherwise healthy?

A 12 lead ECG is the usual starting point, and it may capture some extra beats directly. Because they come and go, a longer recording is often more useful, with an ECG monitor worn for a day or more to show how many ectopic beats there are, when they happen and whether they match what you feel. The British Heart Foundation also mentions an echocardiogram, an ultrasound scan of the heart, to check for any underlying problem with its structure, and blood tests can look for thyroid problems and salt imbalances.

The number matters. An occasional extra beat is a very different finding from a large number throughout the day, and that count, alongside how well the heart is pumping, shapes what happens next.

Treatment, and When None Is Needed

Not all ectopic beats need treatment. When the heart's structure is normal and the beats are infrequent, the most useful outcome of an assessment is often a clear explanation and the confidence to stop monitoring every beat. Dealing with triggers usually comes first.

Where symptoms are troublesome, medication can reduce the extra beats and ease the sensation. The British Heart Foundation notes that beta blockers may be prescribed where an arrhythmia is diagnosed. When ventricular ectopics become very frequent, a procedure called an ablation can isolate the part of the heart that is producing them. Any underlying cause, such as a thyroid problem or a structural heart condition, is treated in its own right.

Heart rhythm disorders are Dr Jogiya's main specialist interest, covering rhythm management, electrophysiology and complex pacing, and he holds the British Heart Rhythm Society examination in electrophysiology and devices. With ectopic beats, the right answer for most people is a confident explanation rather than a prescription, and getting there depends on reading the recording alongside the person who felt the symptoms.

Conclusion

Ectopic heartbeats are early or extra beats that most people have at some point, and they are usually harmless. They can feel alarming, as a thud, a skip or a flutter, and they are often most noticeable at rest or in the evening. Common triggers include caffeine, alcohol, stress, poor sleep and hormonal change, and for many people recognising and reducing those is enough.

They are worth having checked if they are frequent, keep coming back or come with other symptoms, or if you have a heart condition or a family history of heart problems. An ECG, a longer monitor and sometimes an echocardiogram will usually show what the beats are and whether the heart is otherwise healthy, and for many people that answer is what finally puts the worry to rest.

If you are noticing skipped or extra beats and would like them properly assessed, you can contact us at Kingston Cardiologist to arrange a heart rhythm consultation in Kingston upon Thames or central London. Appointments are available in person and virtually, with ECG monitoring and echocardiography arranged where they are needed.