Dear Sir
Thanks for your query to us.

It is not clear from your question that it is a long standing problem or you are currently having a continuing first episode of this problem. If it is continuing first episode, please visit your hospital emergency room and get yourself examined.

The feeling of transient weakness and giddiness can occur with missed beats.
The mechanism for same in most situations is contraction of the atria (the thin chambers of heart mainly acting as storage chamber/receptacles) against the closed valves (atrio-ventricular valve). As a result of this the blood goes back to your jugular vein, where sensors feel excessive pressure and they produce giddiness and weakness. Otherwise these skipped beats mostly make you unusually aware of your heart beat (palpitation).
But this is only a presumptive or speculative mechanism in your case, since we do not know the exact rhythm behind these skipped beats. There can be various type of underlying rhythms of heart associated with skipped beats. We need to know the exact rhythm before we can tell you about its causes and management.
If you ever had blackouts/ blurred vision/loss of consciousness/ vertigo/ chest pain/ significant shortness of breath associated with these palpitations, please see your cardiologist urgently.
Two steps in management of such beats (after clinical examination) are ECG at the time of palpitation and then ECHO. At times when you can not get an ECG done for them (non availability or too small a duration to go to doctor), then we advise 24 hour holter monitoring.
Most of the benign causes of skipped beats when associated with normal ECHO do not require any treatment, if symptoms are not bothersome. If there are significant symptoms they can be tackled mostly with one drug.
Since the skipped beats can be promoted by smoking, excessive tea/coffee/alcohol/ coacine, there use should be avoided. Anti-asthma drugs are top in the list of drugs which can cause this problem.
I would advise you to see your cardiologist at priority and also try get an ECG at time of skipped beats and discuss it with your cardiologist.
Feel free to ask if there is anything else.
Sincerely
Sukhvinder XXXXXXX

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Dear Sir

The best way to go about this issue is to know the exact rhythm disturbance. If you will get an ECG at the time when you are not having symptoms, it may turn out to be normal. But that is not the final thing. Either you get an ECG at time of symptoms or you undergo a long term monitoring (like 24 hours holter monitoring, if you have daily symptoms). That will pick-up the rhythm. Yes, a repeat ECHO will be on cards.

As I mentioned previously that if ECHO is normal, a number of rhythms will require one single drug i.e. beta-blockers. But all these only when we have established the rhythm responsible for your symptoms. That is the crux.

Hope I clarified the issue to you. Feel free to write if there is anything else.

Sincerely
Sukhvinder Singh

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