Skipped beats – missed beats
May people feels skipped beats or missed beats. Some have it more after taking coffee or tea. Others have it after taking an alcoholic drink. Most often it is none these, they just occur. It is mentioned often by people who are in the habit of checking their own pulse.
Most often it is actually not a missed beat, but a pause which occurs after an early or premature beat. The premature beats occurs so early that heart does not get enough time to fill up with blood after the previous contraction. As a result the premature beat either produces a low volume pulse or sometimes no pulse at all. The low volume pulse is often not well felt when you feel it at the wrist. After every premature beat there is usually a compensatory pause. It is the pause which is felt like a missed beat.
Premature beats are usually innocuous if they occur in isolation. But if they occur in a rapid sequence, it becomes an abnormally fast rhythm. Such a rhythm originating from the upper chambers is known as supraventricular tachycardia and that from the lower chamber as ventricular tachycardia. These can be problematic. Large number of premature beats, usually more than 10,000 per day can also weaken the pumping function of the heart if it occurs for a prolonged period.
When the sinus node which is the natural pacemaker fails to produce a beat, that can cause a true missed beat. In heart block, sinus node gives out a signal, but its conduction to the lower chamber is blocked and a beat is missed. These types of missed beats are much rarer than the apparent missed beats due to a premature beat which does not produce a good pulse.
Do missed/skipped beats need treatment?
Occasional missed beats due to premature beats need no treatment if there is no associated structural heart disease. Missed beats due to heart block and abnormal function of sinus node is are of more concern. These can later become more severe and the heart rate drop. If that occurs, it might necessitate the implantation of an artificial pacemaker.
Missed beats in those which structural heart disease need more caution as they are more likely to progress to fast rhythms. The basic disease process should be treated. Some of them may require an EP study.