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Dr. Andrew Rynne
Dr. Andrew Rynne

Family Physician

Exp 50 years

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What causes skipped heart beats with normal heart check up?

Answered by
Dr. Karen Steinberg

Internal Medicine Specialist

Practicing since :1981

Answered : 824 Questions

Posted on Fri, 4 Jul 2014 in Heart Rate and Rhythm Disorders
Question: hello
I asked a question recently about pvcs and pacs. I started having them as a teenager and they have continued (and gotten worse) as an adult ( I'm 32 now). I've had a full work-up (recently) and my heart is structurally normal. my question is this: about 1-2x per month I get an episode where the skipped beat is very bad. today, for instance I had a pause that lasted 3 seconds. I can feel when there's a skip, checked my pulse and felt nothing for that 3 second period (I had a clock right in front of me). I also felt very strange during that period; a feeling that blood was rushing go my head and worried I was going to pass out. when the beats started again, they were fast for about a minute. does this sound like a typical skipped beat and should I go get a second opinion? thanks
Answered by Dr. Karen Steinberg 6 hours later
Brief Answer:
Get a second opinion

Detailed Answer:
Hi, thanks for coming to Healthcare Magic with your questions. I am not sure what you mean by a "full workup." An echocardiogram can show the structure of your heart and if valve abnormalities are present. It does not generally show abnormalities in the heart's electrical system, which controls the heartbeats. I am concerned about your history of PACs and PVCs since you were a teenager, which is now getting worse. The history suggests you may have a disturbance in the electrical system which is causing arrhythmias.

A 3 second pause in heartbeat is NOT a typical skipped beat. It is a pause. The reason you felt like you were going to pass out was because no blood was being pumped to your brain during that time. You would have passed out if it had gone on longer.

A cardiac electrical disturbance called sick sinus syndrome can cause pauses associated with PACs and also fast and slow rhythms. There are some other electrical system conditions that may cause pauses. I have to wonder if the PVCs you have are a sort of "escape" rhythm that occurs when you have the pauses. Such disorders cannot be detected by an echocardiogram nor often by a resting EKG. They require continuous monitoring of your heartbeat over a few days. This is called a Holter monitor. It is a small device that you can wear at home and with usual activities. You don't need to spend any time in a hospital.

If you were my patient, I would be scheduling this procedure and referring you promptly to a cardiologist. This specialist can do further more specific tests to diagnose an arrhythmia. He or she would also be able to initiate treatment. Sick sinus syndrome usually requires a pacemaker. Other conditions may need other types of treatment.

Hope this answers your query. If you have more questions, I would be happy to answer them.
Above answer was peer-reviewed by : Dr. Prasad
Follow up: Dr. Karen Steinberg 1 hour later
Thank you for the answer. I had a 30 day holster monitor last year, an echo, stress test and ecg all through a cardiologist. I say that I thought I was going to pass out because I was worried I would because of the pause in heart beat. I didn't feel light headed or dizzy; I just felt like blood was rushing to my head. Almost an anxiety, hot feeling (if that makes sense).
What exactly is sick sinus syndrome? I have an appointment for a holter monitor on Tuesday. Does this sound like something I should be seen sooner for? Thanks
Answered by Dr. Karen Steinberg 13 hours later
Brief Answer:
You can wait till Tuesday.

Detailed Answer:

Thanks for the further history.

It is reassuring that you had the complete workup. I am still concerned about the length of the pause. It is normal to have a pause after a skipped beat, as the heart is "resetting" its electrical system. Usually they are not as long and you don't feel strange during them. Certainly that feeling could have been from stress and anxiety, and the increase in PVCs and PACs also from anxiety.

Sick sinus syndrome is when the sinus node, which is like the on switch for the heart's electrical system to start sending a beat, is not functioning properly. The sinus node is located on the top chambers of the heart. You can have spontaneous episodes of fast heartbeat or a drop in heart rate. Pauses can occur. There is another node called the AV node which distributes the signal from the sinus node to the lower part of the heart. If the sinus node isn't working, the AV node may become the on switch, which usually causes a slower rate. If the AV node is not working properly, there might be blockages in the signal going to the ventricles, which do the main pumping. This can also slow the rhythm or create pauses. If both of these nodes are not working right, the ventricle itself will spontaneously fire a signal so the heart can keep beating. This will look like a PVC on the EKG (that's what I meant by escape rhythm).

Other abnormalities in the electrical system could cause arrhythmias. Many of these could progress slowly over time. I think it's a good idea to get another Holter since things have changed since the last time. You don't need to get it any sooner than you are, but be sure to keep your appointment on Tuesday. Hopefully this is all due to stress and anxiety and the Holter will reassure us that these things are benign. Please let me know if you have further questions. Best wishes that you feel better soon!

Above answer was peer-reviewed by : Dr. Raju A.T

The User accepted the expert's answer

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