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What Causes Skipped Heart Beats?

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Posted on Wed, 22 Jul 2015
Question: At night, I often have a weird sensation that my heart is skipping a beat, accompanied by my ears almost clogging (not a ringing sound) but almost like I hear nothing during that time. I recently had an EKG during my annual physical and everything was normal. Is there another procedure I should look into? It doesn't happen often so I don't know if it would even be detected if I did the Holter monitor for 24 hours.
doctor
Answered by Dr. Ilir Sharka (49 minutes later)
Brief Answer:
Probable transient hemodynamic alteration should be first sought.

Detailed Answer:

Hello!

Thank you for asking on HCM!

Regarding your concern, I would like to explain that your weird sensation of a skipping heart beat, seems to be related to probable ectopic heart beats.

Because this sensation has associated symptoms, it is necessary to perform a comprehensive physical examination, as palpitations associated with transient hearing impairment (and ear clogging too), most probably may be caused by a sudden hemodynamic alteration.

That is, a possible blood pressure drop may be associated with palpitations and those associated complains.

It is necessary to have a more complete view of your clinical scenario to draw specific conclusions.

Could you explain in details those unpleasant moments (any prodromal signs or symptoms, your general physical conditions when it happens; so is it more frequent when you stand up, or exert? Do you have any chronic health disorders? Associated anemia? Hypertension? Diabetes? Thyroid dysfunction?? etc).

So, to summarize my opinion on the matter, I would say that, besides a careful physical exam, it is necessary to have some medical tests too:

(a) A close and frequent monitoring of blood pressure values (several times daily) is necessary to have a full picture of possible hemodynamic fluctuations (hypotension, orthostatic intolerance, hypertension, etc). For this purpose an ambulatory BP monitoring test could be helpful, as well as frequent independent manually BP measurements.

(b) Some lab tests like complete blood count, fasting blood glucose, thyroid hormone levels, renal function tests and electrolytes, etc

(c) For a better evaluation of possible ectopic heart beats or any other arrhythmic events hidden behind those unpleasant moments, it is necessary to perform an ambulatory 24 to 48 hours ECG monitoring. If reasonable indications exist a cardiac ultrasound would be helpful to exclude structural heart disorders.

If suspicions are raised, probably a more extended arrhythmia events recorder would be suitable.

(d) If no dectable correlations with possible hemodynamic derangements could be found, then an independent hearing system evaluation would be helpful. An audiometry to investigate possible hearing reduction, otoscopy, etc.

Hope to have been helpful to you!

Feel free to ask me whenever you need! Greetings! Dr. Iliri
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ilir Sharka (35 minutes later)
Thank you for the information.

I do not have any prevailing medical issues besides being overweight (which can lead to many issues I know). No diabetes, thyroid, hypertension or anemia.

I only notice it happening at night when I am lying in bed as I am falling asleep so no exertion or strenuous activity is experienced prior to the event.

I was experiencing unusual swelling in 2013 and had a cardiac ultrasound, as well as a renal screening, which all came back within normal limits (my kidney is smaller than normal - my sister's also so I assume it is just normal for my family).

The swelling went away after awhile with no explanation and I have not had any additional issues since. My recent blood work all came back normal and, as mentioned, my EKG was normal.
doctor
Answered by Dr. Ilir Sharka (2 hours later)
Brief Answer:
Probably nothing clinically significant, just consult an ENT specialist.

Detailed Answer:

Hi again!

Coming to this point, those rare skipping heart beats don't look clinically important. Nevertheless, if they become frequent and disturbing a Holter monitoring would be advisable and helpful.

Keep monitoring your blood pressure,

Just consult an ENT specialist for those ears clogging complains.

Regards! Dr. Iliri
Note: For further queries related to coronary artery disease and prevention, click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Ilir Sharka

Cardiologist

Practicing since :2001

Answered : 9536 Questions

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What Causes Skipped Heart Beats?

Brief Answer: Probable transient hemodynamic alteration should be first sought. Detailed Answer: Hello! Thank you for asking on HCM! Regarding your concern, I would like to explain that your weird sensation of a skipping heart beat, seems to be related to probable ectopic heart beats. Because this sensation has associated symptoms, it is necessary to perform a comprehensive physical examination, as palpitations associated with transient hearing impairment (and ear clogging too), most probably may be caused by a sudden hemodynamic alteration. That is, a possible blood pressure drop may be associated with palpitations and those associated complains. It is necessary to have a more complete view of your clinical scenario to draw specific conclusions. Could you explain in details those unpleasant moments (any prodromal signs or symptoms, your general physical conditions when it happens; so is it more frequent when you stand up, or exert? Do you have any chronic health disorders? Associated anemia? Hypertension? Diabetes? Thyroid dysfunction?? etc). So, to summarize my opinion on the matter, I would say that, besides a careful physical exam, it is necessary to have some medical tests too: (a) A close and frequent monitoring of blood pressure values (several times daily) is necessary to have a full picture of possible hemodynamic fluctuations (hypotension, orthostatic intolerance, hypertension, etc). For this purpose an ambulatory BP monitoring test could be helpful, as well as frequent independent manually BP measurements. (b) Some lab tests like complete blood count, fasting blood glucose, thyroid hormone levels, renal function tests and electrolytes, etc (c) For a better evaluation of possible ectopic heart beats or any other arrhythmic events hidden behind those unpleasant moments, it is necessary to perform an ambulatory 24 to 48 hours ECG monitoring. If reasonable indications exist a cardiac ultrasound would be helpful to exclude structural heart disorders. If suspicions are raised, probably a more extended arrhythmia events recorder would be suitable. (d) If no dectable correlations with possible hemodynamic derangements could be found, then an independent hearing system evaluation would be helpful. An audiometry to investigate possible hearing reduction, otoscopy, etc. Hope to have been helpful to you! Feel free to ask me whenever you need! Greetings! Dr. Iliri