Skipped heartbeats: causes, red flags and when to get it checked

The heart has its own electrical pacemaker, but other areas of the heart muscle can occasionally fire early. The early beat is weak, so you may not feel it; the following beat comes after a pause and is stronger because the heart has had more time to fill. That is what feels like a skip or a thud.

• Premature atrial or ventricular beats in a healthy heart, often noticed at rest or at night.

• Caffeine, alcohol, nicotine, energy drinks and recreational stimulants.

• Stress, anxiety and sleep deprivation.

• Medicines such as inhalers, decongestants and thyroid hormone, and low potassium or magnesium.

• Overactive thyroid, anaemia and fever.

• Atrial fibrillation or flutter, with a more sustained irregular rhythm.

• Heart disease: previous heart attack, cardiomyopathy or valve disease, where ventricular ectopics are more significant.

• Inherited rhythm disorders, which are rare.

Beats that come frequently or in runs, a fast sustained pulse, fainting, near-fainting, chest pain, breathlessness, a known heart condition, a family history of sudden death or inherited heart disease, or ectopics that increase during exercise warrant specialist assessment.

• Call 999: skipped beats with chest pain, collapse or severe breathlessness.

• Same-day GP or NHS 111: a persistent very fast or irregular pulse with dizziness.

• GP within a week or two: frequent skipped beats, palpitations that come in runs, or with a family history of sudden cardiac death.

• Routine: occasional skips that are brief and linked to caffeine or stress.

Doctors ask how often, when, how long, triggers, caffeine, alcohol, drugs, medicines, thyroid symptoms, exercise effects and family history. They check pulse, blood pressure, heart sounds, thyroid and signs of anaemia.

• ECG: often normal between ectopics, but can show other abnormalities.

• Ambulatory ECG monitoring: to count ectopics and rule out arrhythmias.

• Blood tests: thyroid function, electrolytes, full blood count and ferritin.

• Echocardiogram: if there is a heart murmur, frequent ectopics or heart disease.

• Exercise test: to see how ectopics behave with exertion.

Cut back caffeine, alcohol and nicotine, improve sleep and manage stress. Understanding that ectopics are usually harmless often reduces them by reducing anxiety and adrenaline. Avoid constantly checking your pulse. Regular moderate exercise is generally helpful.

The NHS route is a GP and ECG, with cardiology referral for frequent ectopics or high-risk features. Private cardiology offers prompt ECG, monitoring and echocardiography.