Ectopic heart beats: causes, symptoms and when to worry
Many people are surprised and understandably concerned when they notice their heart skipping, fluttering or beating irregularly. These sensations are often caused by ectopic heart beats.
In this article, consultant cardiologist and electrophysiologist Dr Rahul Mukherjee explains what ectopic heart beats are, why they occur, how they are investigated and when treatment or further assessment may be required.
What are ectopic heart beats?
An ectopic heart beat is an extra heartbeat that occurs earlier than it should. Instead of following the heart’s normal rhythm, the beat comes from an unexpected (ectopic) area of the heart.
There are two main types:
- Atrial ectopic beats: originating from the upper chambers of the heart (atria)
- Ventricular ectopic beats: originating from the lower chambers (ventricles)
After an ectopic beat, there is often a brief pause before the next normal beat. This pause is what many people notice as a “missed beat”.
What do ectopic beats feel like?
The symptoms of ectopic heart beats vary from person to person. Common descriptions include a sudden thud in the chest, a skipped beat, brief fluttering or an awareness of an irregular heartbeat. Some people also notice a fleeting sensation of breathlessness.
These symptoms are often more noticeable at rest, when lying down or during quiet moments, as there are fewer distractions from bodily sensations.
What causes ectopic heart beats?
Ectopic beats can occur in completely healthy hearts. Common triggers include:
- Stress or anxiety.
- Tiredness or lack of sleep.
- Caffeine (tea, coffee, energy drinks).
- Alcohol.
- Smoking.
- Dehydration.
They may also be more frequent during illness, after exercise, or during hormonal changes such as pregnancy or menopause. In some cases, ectopic beats are associated with underlying heart disease, although this is far less common.
Are ectopic heart beats dangerous?
In the vast majority of individuals, ectopic beats are benign and do not indicate serious heart disease. They do not increase the risk of heart attack or sudden cardiac death when the heart structure is normal.
Further investigation is advisable if ectopic beats are very frequent, symptoms are worsening, there is known heart disease, or episodes are accompanied by fainting, chest pain or significant breathlessness.
How are ectopic heart beats diagnosed?
Assessment begins with a detailed clinical history and examination. An electrocardiogram (ECG) may identify ectopic beats, although longer monitoring is often required. This may include a 24-hour or extended heart rhythm monitor to capture symptoms.
An echocardiogram, or heart ultrasound, is commonly performed to assess heart structure and function. These tests are particularly helpful in providing reassurance.
How are ectopic heart beats treated?
Most ectopic beats do not require treatment. Management often focuses on reassurance and lifestyle changes, such as reducing caffeine or managing stress.
If symptoms are troublesome, options may include:
- Medications to reduce ectopic beats.
- Treating underlying triggers such as anxiety or sleep problems.
- In rare cases, specialist procedures for very frequent ectopics.
Ectopic heart beats are common and usually harmless, despite often feeling distressing. If symptoms are persistent, severe or associated with other warning signs, specialist assessment can provide clarity and peace of mind.