Heart “skipping a beat” is usually a form of heart palpitations, most often harmless, but it can have other causes and, in some cases, may indicate an underlying issue. Here’s a clear breakdown to help you understand what it might mean and when to seek care. What people commonly feel

• A sudden, brief sensation that the heart skipped a beat, paused, or fluttered, followed by a normal beat. This can feel like a thump, a flip, or a momentary pause in the chest or throat.

Common causes (many are benign)

• Normal variants of heart rhythm, especially in young people or during stress, caffeine, alcohol, or dehydration.
• Premature beats (early heartbeats) from the atria or ventricles. The next beat may feel stronger or louder due to a short pause after the premature beat.
• Increased adrenaline from stress, anxiety, caffeine, nicotine, or stimulant medications.
• Exercise or exertion, especially if you're not conditioned or are dehydrated.
• Hormonal changes (e.g., thyroid fluctuations, pregnancy, or certain menstrual-cycle phases).
• Certain medications or supplements that affect heart rhythm, including decongestants or some asthma or allergy medicines.
• In some cases, underlying heart conditions (less commonly in healthy individuals) such as structural heart disease, electrolyte imbalances, or arrhythmias.

When palpitations are likely benign

• They occur intermittently and are brief.
• They’re not associated with chest pain, fainting, shortness of breath, or significant dizziness.
• They happen in the setting of normal blood pressure and a healthy heart on examination or a routine ECG.

Red flags that require prompt evaluation

• Palpitations with chest pain, severe shortness of breath, fainting, dizziness, or confusion.
• Palpitations that are persistent, happen very frequently, or occur with very rapid pulse.
• A history of heart disease, significant risk factors, or a family history of sudden cardiac death.
• Palpitations that change in character (e.g., become consistently rapid, irregular, or associated with fever or dehydration) or do not resolve with rest.

What to do next

• If you’re currently experiencing new, persistent, or worrisome symptoms, seek medical evaluation, especially if red-flag symptoms are present.
• Track episodes: note the onset, duration, any triggers (caffeine, alcohol, stress), and accompanying symptoms. This information helps clinicians assess risk.
• Basic checks you can do at home:
  • Ensure adequate hydration; limit caffeine and alcohol if you notice a pattern.
  • Consider regular meals and balanced electrolytes; avoid skipping meals.
  • Review medications and supplements for items that can affect heart rhythm.
  • If you have a home pulse monitor, a few normal readings between episodes are reassuring, but don’t rely on it alone.
• When to seek immediate care: if you experience chest pain, fainting, severe shortness of breath, or a very rapid, irregular, or persistent heartbeat.

Longer-term considerations

• For frequent or bothersome palpitations, a clinician may assess with:
  • Physical exam and history
  • ECG (electrocardiogram) or ambulatory monitoring (like a Holter monitor) to catch intermittent episodes
  • Blood tests to check electrolytes, thyroid function, and other factors
  • Evaluation for anxiety or stress-related contributors

Bottom line

• Most heart skipping episodes are benign, especially in people under 40 without heart disease. However, persistent, worsening, or accompanied by alarming symptoms warrants medical evaluation to rule out arrhythmias or other conditions. If in doubt or if red flags are present, seek prompt medical attention.