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Feeling Skipped Heartbeat, Pain In The Hands And Feet. Are These Related?

Posted on Wed, 10 Apr 2013

Question: Sometimes it feels as if my heart skips a beat and/or has an extra beat; regardless, it just feels like the rhythm experiences a hiccup. I notice this "hiccup" mostly right beneath the middle of my breast bone. I don't feel like it is acid reflux or air either. I have been noticing this on and off, what can it be? I've also and even pain in both my hands and feet that worsen at night. It feels like a radiating pain the has been increasingly growing (up the arms and the legs). It prevents me from a good night's sleep sometimes. Is this at all related?

Answered by Dr. Anantharamakrishnan (38 minutes later)

Hi friend,
Welcome to Health Care Magic

Feeling of ‘dropping / skipping / missed’ beat is ECTOPIC beats / Arrhythmia.
A beat comes earlier than normal – this itself is not usually felt. The next beat is a bit delayed - longer time to recover form early extra beat – so heart fills more and the beat appears forcible – thud / lubb - - dubb - - lubb - - dubb - lub - - - DUBB

Ectopic beats can arise from ventricle (lower chamber of the heart - Ventricular Ectopic; VPC) / or Atrium (upper chamber - Atrial Ectopic; APC).
APCs are generally harmless. Even VPCs are often harmless – ‘benign’.
If they are frequent - more than 5 per hour, 2 or more beats coming consecutively – they should be investigated further.

Irregular heart beats need to be DOCUMENTED by ElectroCardioGram (EKG).
THE FIRST STEP IS TO SEE A CARDIOLOGIST
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     Anxiety / Alcohol / Tobacco (smoking, chewing) / Caffeine (too much coffee, cola) are common causes.
     Medicines may be responsible – like Phenylephrine used for ‘cold’ / Salbutamol used for asthma and so on.
Illicit ‘drugs’ like Amphetamine are notorious to cause abnormal beats
At times, abnormal nerve paths in the heart (bypass tracts) are responsible!
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These beats are common and often may be normal.
Yet it is advisable to have it investigated.

A thorough history and physical examination is the first step -
ECG (Electrocardiogram / EKG) – Routine 12-lead – is part of clinical examination.
     HOLTER (24 to 48 hour ambulatory monitoring) is done to analyse and plan for further management, if a routine ECG does not show,
     ECHOcardiogram is necessary to see the heart valves (Mitral Valve Prolapse) / heart muscle (Cardiomyopathy) and heart function (Ejection fraction, wall motion abnormality).
      TMT (Treadmill exercise ECG) is done to exclude Ischemia (reduced blood flow).
     LABORATORY work-up is routine - like blood counts, sugar, urea, electrolytes (potassium in particular), thyroid (over-active) and so on. Your Internist shall suggest based on the situation.

If there are no clues and if the problem is still bothering to the extent of interfering with life style, there is advanced technique of investigation – Electro Physiological Studies (EPS)
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     These ectopic beats are not always symptomatic.
The feeling depends on individual sensitivity – some do not feel them at all / some may feel every beat.
     Specific treatment may not always be necessary.
     The first line medicine is generally beta blockers, like Metoprolol – slow release and small dose.
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Discuss with your doctor...
Medicine is well advanced nowadays – management is possible for almost all situations...

Take care
Wishing speedy recovery
God bless
Good luck

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

Follow up: Dr. Anantharamakrishnan (7 minutes later)

Thank you Dr. Anantharamakrishnan for your reply. I do feel more than half a dozen of these in an hour, but it doesn't happen every hour.

Along with this "skipped beat", I have had fatigue, sore joints (hands and feet), and blurry vision (optometrist said it may be due to chronic dry eyes, but gave no further explanation). Could these symptoms reveal a systemic issue that may be connected to what has caused my interstitial cystitis?

*I refrain from most caffeinated foods and drinks. I also don't smoke or use drugs other than my prescribed medication for IC.

Answered by Dr. Anantharamakrishnan (14 minutes later)

It is not likely to be a systemic issue related to the cystitis / nor from your treatment for it...
Get yourself investigated / you need an event monitor - for further analysis with a view for appropriate management

Regards

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

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