I have chest pain and an intermittent heartbeat. What causes it?

Question

Hello doctor,

I am a 55-year-old male. I am 5 feet 10 inches tall and weigh 165 lbs. Recently, I have been experiencing what feels like a skipped heartbeat. It is very intermittent and had occurred once before, a few months ago, but then subsided.

This sensation started again about five days ago and has been happening intermittently since then, seeming more noticeable in the mornings over the last three days.

I have symptoms such as slight tightening or an empty sensation in my upper abdomen, chest, and neck, very faint but enough to make me check my pulse. When I do, it sometimes feels like there is a delayed or skipped beat.

I have checked my heart rate and blood pressure several times, and both have been normal. I also ran a home EKG, which was normal, though the skipped beat did not occur during the recording.

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

Thank you for describing your symptoms so clearly; that really helps in understanding the situation.

What you are experiencing sounds like intermittent skipped or delayed heartbeats, which are often due to premature beats, either premature atrial contractions (PACs) or premature ventricular contractions (PVCs).

These are quite common and, in many healthy adults, can occur occasionally without indicating serious heart disease.

The sensations you describe, a skipped beat, slight tightening or hollow feeling in the chest or upper abdomen, and the fact that it happens intermittently and more often in the morning, are consistent with these benign rhythm irregularities.

They can be triggered by stress, caffeine, poor sleep, dehydration, alcohol, or anxiety. However, since the episodes have recurred and become more noticeable, it is important not to ignore them.

Your blood pressure and heart rate readings are within normal range, and the home ECG (electrocardiogram) being normal is reassuring, but since the skipped beats did not occur during the recording, they might not have been captured. So I am suggesting a few tests to do:

Get a clinical ECG and a 24 to 48-hour Holter monitor test, which continuously records your heart rhythm and can detect intermittent skipped beats accurately.
Basic blood work to check, especially electrolytes, thyroid function tests, fasting glucose, and magnesium and potassium levels, since imbalances can cause rhythm disturbances.
Limit stimulants like caffeine, energy drinks, and alcohol.
Maintain hydration and adequate sleep.
Observe warning signs; if you ever experience chest pain, fainting, severe dizziness, shortness of breath, or a sustained rapid heartbeat, seek medical attention immediately.
Schedule a review with a cardiologist, who can evaluate whether these are benign or if any further cardiac imaging (echocardiography) is needed.

In many people, these skipped beats turn out to be harmless and self-limiting, especially if all tests are normal. But confirming that through proper monitoring will give you both clarity and peace of mind.

I hope this helps.

Thank you.