Ectopic Heartbeat Explained Simply
What are ectopic heartbeats?
An ectopic heart beat is a premature and largely unsuccessful contraction that occurs between regular heart beats. In the case of premature ventricular contractions, an impulse to beat comes from inside the ventricle rather than through the normal conduction pathway.
This means that the ventricle beats before it is due to and consequently may not be completely ready and is not fully filled with blood. When the next beat cycle comes around, the ventricles will be over-filled with blood and can beat with a lot of force.
Ectopic beats are normal and occur in a large proportion of the population but for most, they are transient - 'my heart skipped a beat'. This type of arrhythmia is usually not a cause for concern, but they have the potential to cause great anxiety in prolonged sufferers.
Ectopic beats are common. People may feel like their heart is skipping a beat, is missing a beat or may feel a thump in their chest.
The way someone experiences ectopic heartbeats is very personal to that individual. It is usual to feel a fluttering or thumping in the chest on the left, but it can also be felt in the left of the neck and sometimes in the left shoulder. This can leave the sufferer feeling anxiety and wondering whether the problem is a more serious issue.
This article covers the causes, symptoms, and complications for ectopic heartbeats.
Some other names for palpitations depending upon presentation are:
- Premature Ventricular Contractions (PVC's)
- Premature Atrial Contractions (PAC's)
- Ectopic Heartbeat
- Missed Beats
- Arrhythmia
- Skipped Heart Beats
- Extra Beats
Outline of a missed heartbeat
Ectopic heartbeats are sometimes described as a premature or extra heartbeat. It is caused by erroneous nerve firing causing an attempted beat in the heart muscle before it is ready. This causes a pause in the heart beating before the next beat.
An ectopic heartbeat is when it feels like the heart either skips a beat or adds an extra beat. In reality it is an incomplete beat that is most usually followed by a normal heartbeat.
Sometimes the heart can miss two complete beats, which is called bigeminy or three, which is trigeminy. These are also not a reason for alarm even though they can be emotionally troubling.
Ectopic heart beats are usually benign in nature unless underlying heart disease is the cause of them. They may occur randomly for no good reason. Regardless of the skipped or added beat, the heart otherwise functions normally.
People experiencing ectopics may become worried if they feel their heartbeat skipping or thumping. Anxiety is often a cause of ectopic beats and can make their experience worse. But they will usually stop by themselves.
Two types of ectopic heartbeat are:
- Premature atrial contractions (PAC). These originate in the upper chambers of the heart, called atria.
- Premature ventricular contractions (PVC). These originate in the lower chambers of the heart, called ventricles.
Ectopic heartbeats are quite common in adults. They occur much less frequently in children and usually occur due to underlying heart disease. When children experience benign ectopic heartbeats, they are often PAC and are usually harmless.
The likelihood of experiencing a premature ventricular contraction grows as people become older. A previous heart attack, anxiety disorder or a family history of ectopics may increase the risk of someone developing PVC's as they age.
Causes of palpitations
In my experience, ectopic heart beats are first initiated by a traumatic event. These can be emotional or physical in nature. Once you have experienced your first bout of ectopics, there are several risk factors and triggers that increase the chance of further bouts of ectopics.
Possible factors and triggers of ectopic heartbeat episodes include:
- caffeinated drinks like tea and coffee and foods containing caffeine
- smoking
- anxiety or stress
- emotional burnout
- recreational drug use
- drinking alcohol
- exercise
- decreased potassium levels
- certain prescription medications
- some allergy and cold medications
- asthma medications
There are also several underlying conditions that have the potential to be underlying causes or risk factors for ectopic heartbeats that include:
- a family history of ectopic heartbeats
- previous heart attack
- underlying heart disease
Overcome Your Ectopic Heartbeat in 30 Days
How ectopic symptoms present
You can have an ectopic heartbeat with no physical symptoms. In other instances, people may sense that their heart is skipping or had an extra beat by feeling it in their chest or sometimes in their throat. Somtimes the feeling is of a thumping in the chest with each missed beat or palpitations.
Thus the expression of ectopic symptoms is on a spectrum with not feeling them much at all at one end and thumping in the chest at the other.
Some people experience more extreme symptoms that are similar in nature to those of more serious heart problems or conditions.
Typical symptoms of palpitations can include:
- an awareness of the heart beating in the chest
- a thumping in the chest
- a feeling of faintness, dizziness or being spaced-out
- a silent sensation of the heart stopping for a moment
- a racing heartbeat
- a fluttering feeling in the chest or neck
- The heart pounding in the chest
Diagnosis of arrhythmias
Some people don't display any symptoms of ectopics. A person may never know they have had an ectopic heartbeat and only discover it when it is picked up through testing for other issues.
If someone experiences regular symptoms, they should speak to their doctor. In some cases, the patient will be referred to a cardiologist for further tests.
A cardiologist will take a detailed history and perform a thorough examination to rule out causes from underlying heart disease. Ectopic heartbeat can often be diagnosed through discussion of the symptoms that a person is experiencing. A stethoscope may be used on a person's chest to listen for an irregular beat known as an arrhythmia and blood pressure readings may be taken.
The cardiologist has many diagnostic tests that they can perform and these are listed below. They then look for any abnormalities in the readings.
The result of these tests and examinations will form the diagnosis.
Diagnostic tests used can include:
- a Holter monitor which is a heartbeat recording device that a person wears for 24 hours
- electrocardiogram (ECG), which measures both the heart's rhythm and electrical signals
- echocardiogram, or ultrasound of the heart
- coronary angiography, or contrast X-ray of the heart
- cardiac MRI to look at the structure of the heart
- exercise testing
- blood tests to look at electrolyte levels and thyroid function
Treatments for ectopic heartbeat
In many cases, after diagnosis, doctors don't treat an ectopic heartbeat as in some instances, the symptoms may reduce with no intervention. Sometimes some lifestyle changes are needed to reduce or eliminate symptoms. These can be:
- reduce caffeine
- reduce alcohol intake
- stopping smoking
- improve sleep duration and quality
- stress reduction
These lifestyle changes are listed in my Breathe Easy Program along with sections on beneficial habits you can adopt to help reduce symptoms. The program has at its heart (pun intended), breathing exercises that treat the underlying cause of ectopics without medical intervention.
However, in the medical model, if symptoms do not decline after a period of time, a doctor is likely to want to explore and treat the underlying condition.
There are two main ways of treating ectopic heartbeat in Australia. Patients can be given beta-blockers or cardiac ablation, which is described as a procedure rather than surgery.
Beta Blockers are drugs that slow the transfer of electrical impulses between nerve fibres. These drugs effectively slow the heart rate down and with it, the abnormal heart rhythm.
There are many beta blockers on the pharmaceutical market, and it can be trial and error to find one that suits you and your condition.
There are down sides to using beta blockers. They slow the heart rate down and it may be difficult to exercise. Tiredness and fatigue may be experienced. See my blog post on beta blockers.
Cardiac ablation is a non-surgical procedure where a catheter is inserted into the heart, usually through the femoral vein in the leg. A part of the tip has an electrode that can burn away the area that is causing the rogue impulse. Cardiac ablation usually takes three to six hours to complete, but complicated procedures may take longer.
Ablation carries its own potential risks (% chance). These can be:
- chest pain in many cases
- Damage to your blood vessels where the catheter may have scraped as it traveled to your heart
- Damage to your heart valves
- Narrowing of the veins that carry blood between your lungs and heart (pulmonary vein stenosis)
- Damage to your kidneys from dye used during the procedure
- infection
- bleeding around the heart (pericardial effusion) (0.2%)
- haematoma in the groin (0.5%)
- heart tissue damage from the ablation requiring a permanent pacemaker (0.5%)
- stroke (0.1%), and
- death (0.1% up to 1.35%)
The death rate varies among different medical facilities depending upon specialisation and experience. The take-home story here is if you choose ablation, you should find a surgeon or clinic well experienced in performing this procedure.
Further reading on this at:
Ablation for Ventricular Ectopics
Death risk from cardiac ablation
Complications of arrhythmias
It is unusual that a person will transition to other types of arrhythmia from their ectopic heartbeat but in some rare instances they may develop the following:
- Ventricular tachycardia, which is a rapid and sometimes irregular heartbeat
- Other types of arrhythmia
People who have suffered a previous heart attack and who have an ectopic heartbeat are at a greater, although low, risk of ventricular fibrillation, cardiac arrest and death.
Ectopic beats and pregnancy
It is normal to experience ectopic beats and arrhythmias during pregnancy. During this time both oestrogen and progesterone are extraordinarily high. These hormones prepare the body to carry and nurture a growing foetus.
In my downloadable article, The Progesterone-Hyperventilation Connection, I write that higher progesterone levels during a normal menstrual cycle can affect a woman's breathing and ultimately her blood chemistry through altered carbon dioxide levels in her lungs. With pregnancy, this effect can be amplified. These changes can lead to an increase in heart rate and may cause people to notice extra beats.
This altered or disordered breathing can set off gestational ectopic heartbeats, which may resolve after childbirth or may remain for longer.
It's not uncommon for the foetus to have ectopic beats. In most cases, ectopic beats or even faster than normal beats are not a cause concern for doctors. Typically, any arrhythmia will be picked up during routine foetus heart monitoring and an obstetrician will decide if any treatment is needed.
Further information on hormone fluctuations in pregnancy
Menopause is also a time of fluctuating hormone levels and this, too, can initiate or increase the intensity, frequency and duration of ectopic episodes
Other types of irregular heartbeat
Ectopic heartbeats are just one type of arrhythmia that a person may experience in their life. Arrhythmias can also involve the heart beating faster than normal, too slow, or in a different rhythm than usual.
One example of an irregular heartbeat is atrial fibrillation (AF). When AF occurs, the upper chambers of the heart, called the atria, quiver rather than contract. Meanwhile the ventricles contract more normally. Atrial fibrillation is not common in children.
Other types of irregular heartbeats that people can have include:
- supraventricular tachycardia
- atrial flutter
- ventricular tachycardia
Ectopic Heartbeat Prognosis
A person may go through life never realising that they have experienced an ectopic heartbeat. In other cases, they may strongly feel that their heart is skipping or thumping in their chest or neck. Ectopic heartbeats are not usually a cause for concern although their presence may be distressing.
If ectopic beats do not clear naturally or are recurring frequently, a person should speak to their doctor. An examination will determine if there is underlying heart disease and what is causing this irregular heartbeat.
Typical treatment involves avoiding triggers, such as smoking or drinking alcohol, and treating the underlying cause of the ectopic beats. The Breathe Easy Program helps you overcome your ectopic heartbeat by treating the cause of ectopics as well as helping you find and avoid triggers.