Extra or premature heart beats

Extra or premature heartbeats—often described as a missed beat, flutter, or sudden jolt in the chest—are extremely common. Many people notice them during periods of stress, tiredness, or after stimulants such as caffeine. Although they are usually harmless, persistent or troubling symptoms may signal an underlying heart rhythm problem that needs specialist assessment

What Are Ectopic Heartbeats?

Ectopic or premature heartbeats occur when the heart contracts earlier than expected, briefly disrupting the normal rhythm.
These extra beats can arise from:

The atria (upper chambers) — Premature Atrial Contractions (PACs)
The ventricles (lower chambers) — Premature Ventricular Contractions (PVCs)

Most people experience these beats occasionally without any impact on their health. However, frequent ectopics or those associated with symptoms may require further evaluation.

Common Symptoms

Some individuals barely notice ectopics, while others may experience one or more of the following:

Sudden “thump” or “jump” in the chest
A feeling that the heart has paused or added an extra beat
Palpitations
Fatigue or reduced energy
Sensation of pounding in the neck
Light-headedness or dizziness
Anxiety or breathlessness

When to Seek Urgent Medical Attention

Most ectopic beats are benign. However, urgent or emergency care is recommended if ectopics occur alongside:

A persistently irregular or very fast heartbeat
Shortness of breath
Fainting or near-collapse
Chest discomfort or pressure
Sweating, clamminess, or sudden coldness
Severe dizziness or confusion
Pain radiating to the arm, jaw, shoulder, or abdomen

These symptoms may indicate a more serious cardiac condition.

What Causes Ectopic Heartbeats?

Ectopics often occur in healthy hearts, but several factors can increase their likelihood, including:

Lifestyle and physiological triggers

Excess caffeine or energy drinks
Stress, anxiety, or poor sleep
Smoking
Alcohol or recreational drugs
Dehydration
Hormonal changes (e.g., adrenaline surges)

Cardiac causes

Coronary artery disease
Heart failure
Heart muscle inflammation or scarring
Cardiomyopathy
Mitral valve disease or mitral valve prolapse
Congenital defects such as an atrial septal defect
After a heart attack

Non-cardiac medical conditions

Thyroid overactivity
Low potassium or magnesium
Anaemia
Low oxygen levels
Medication side effects

Woman experiencing premature heart beats/ ectopics

How Ectopics Are Diagnosed

Diagnosis starts with a detailed history and examination to understand your symptoms and rule out red flags. Investigations may include:

Electrocardiogram (ECG) – the first step in assessing your heart rhythm
Holter monitoring (24–48 hours) – helpful for detecting frequent ectopics throughout daily activities
Long-term event monitoring – for intermittent symptoms that come and go
Echocardiogram – to assess heart structure and function
Blood tests – including thyroid function and electrolytes
Exercise testing – to understand how exertion affects your rhythm

Together, these tests help identify whether ectopics are benign or linked to an underlying cardiac condition.

Treatment Options

Treatment is tailored to the frequency of your ectopics, their impact on your day-to-day life, and whether an underlying cause is found.

Lifestyle measures may significantly reduce symptoms, such as:

Cutting down on caffeine, alcohol, and nicotine
Improving sleep routine
Reducing stress
Staying hydrated

If symptoms persist, medication may be recommended, including:

Beta-blockers
Calcium channel blockers
Anti-arrhythmic drugs

For individuals with troublesome ectopics that originate from a specific focus within the heart, catheter ablation is a highly effective treatment. This minimally invasive procedure targets and neutralises the small area of tissue responsible for triggering extra beats.