Are pounding heart and skipped heartbeat signs of atrial fibrillation?

Q. I feel as if my heart is pounding irregularly. Can it be atrial fibrillation?

Answered by
Dr. Rishu Sharma
and medically reviewed by Dr. K Shobana
This is a premium question & answer published on Sep 20, 2017 and last reviewed on: Jun 08, 2023

Hello doctor,

I am a 46-year-old female. My blood pressure is low and normal. I have never had any heart issues except palpitations when pregnant 10 years ago. They did a cardiac ultrasound at that time, which was normal. Just over a week ago, I started feeling, intermittently during the day, as if my heart were pounding irregularly. Each time, it lasts just a minute or two and then resolves. I saw my doctor, who heard some skipped beats through the stethoscope. The in-office EKG was normal (I did not feel my chest pounding at that time) as was the bloodwork (CBS, thyroid, and electrolytes). She decided to order a monitor for me, but the office cannot get me in for a month. I was talking to my father-in-law, who has had a number of heart problems, and he recommended, in the meantime, the Kardia monitor, a direct-to-consumer, 1-lead ECG machine (AliveCor). I ordered one of these, and the first test I did was evaluated by their cardiologists as a 'possible atrial fibrillation.' Since then, I have done a number (dozens) of home tests. During the times when my heartbeat feels funny, the algorithm has frequently said 'possible atrial fibrillation or that it is indeterminate, that is, beyond the bounds of their analysis mechanism. I am not experienced enough to read the strips myself and was hoping I could email a number of the concerning ones to you in a PDF format for an evaluation. The chest sensation is not painful, but it is disconcerting, and I am anxious to get to the bottom of it. I do not know if this is relevant, but very shortly after the heartbeat issues started, I also came down with a flu-like virus. The kids have just gone back to school and started passing around the bugs. One of my sons is down with the same thing. Thanks so much for your time and help.



Welcome to

I have gone through your detailed narration and understand your concerns. The ECG (electrocardiogram) recordings are clearly suggestive of atrial fibrillation (AF) and there is no doubt about it. The P-wave is absent and the rhythm is irregular. Both are suggestive of AF. Atrial fibrillation occurs when the atria, or upper chambers of the heart, lose their normal rhythm and beat chaotically. The most likely cause of AF in a female is a thyroid problem. But, as your blood work is normal, a test is suggested. It is a 2D echo. It is done to see if there is any clot in the heart due to AF. A therapy with beta-blockers like Metoprolol would be started after doing the 2D echo. Two main strategies are available for the management of atrial fibrillation, which is rate control and rhytm control. The aims of heart rate control in atrial fibrillation are to minimise symptoms associated with excessive heart rates and to prevent tachycardia‐associated cardiomyopathy. Digoxin, beta-blockers, Diltiazem, and Verapamil slow the heart rate but rarely restore the sinus rhythm. Amiodarone, Disopyramide, Flecainide, Quinidine, and Sotalol can be used to prevent the relapse of atrial fibrillation after electrical cardioversion. But initially, a 2D echo should be done.

Hello doctor,

Thanks so much for your thoughtful response.

I have emailed my primary care doctor with your insights and she called the cardiology department and had them move my appointment to get a Holter monitor this week. I believe that the initial appointment will be with a technician or, maybe, a nurse practitioner, but I will bring some of the readouts and ask about an echo. I am wondering if it is possible that being sick with this flu-like virus could have triggered the fast heart-rate and the atrial fibrillation or arrhythmia? And, could it possibly resolve once I am completely well? I am so puzzled as I do not seem to have any of the risk factors listed for this condition and it has come on so suddenly. Thank you again for your help. I deeply appreciate it and wish your practice were here in my city.



Welcome back to

The golden rule of medical science is that there is no rule. Every human body is different. Therefore, what can cause a problem in one person can be safe for other. Flu is not one of the common causes of atrial fibrillation. So, my primary advice is to look for common things. Myocardial ischemia (a decreased blood supply to the heart) is one of the most common causes and should be ruled out immediately. 2D echo and a stress test should be done on you right away. Feel free to follow up.

Hello doctor,

Thanks so much for this second response.

Your advice has been invaluable. I feel I am well-armed with information for my appointment and I will ask them about the echo and the stress tests. I will also follow up with you afterward. In the meantime, I will plan to rest and try to get over this flu.Thank you again for your help. You have been a reassuring voice in this surprising and rather unpleasant experience and I am so glad I reached out.



Welcome back to

Thank you for your kind words. I wish you a great luck. Do not worry. It is easy to treat atrial fibrillation and it is not fatal if treated properly. Best wishes.

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