Peter Hibberd, M.D., is a doctor whose advice is based on more than 28 years of hospital outpatient and inpatient experience. He is an experienced emergency medicine physician, surgeon, and consultant. Dr. Hibberd is certified by the American Board of Emergency Medicine. He is also a fellow and active member of the American Academy of Family Physicians, an active member of the American College of Emergency Physicians, and a member and fellow of the American Academy of Emergency Medicine. Dr. Hibberd has earned numerous national and international professional certifications, memberships, and awards.

Diagnosing 'Skipped Heartbeats'

Tuesday, 22 November 2011 11:36 AM

Question: For the past 10 years, I've had an occasional skipped heartbeat that almost feels like a spasm in my throat. It seems random — sometimes once in three or four beats, sometimes once in 20 to 30 or more beats — and then it goes away. I have recently had stress EKG's and a scan which didn't find anything. Can this maybe be an electrical, sinus node problem?
Dr. Hibberd's Answer:
It's important to investigate these sorts of episodic sensations until you find the cause. If your heart monitor is clear, consider carrying a heart monitor that you can place against your chest. It will record your heartbeat during your symptoms and clarify whether you are feeling a heart or other muscle contraction. Usually, you will have the heart monitor reviewed before resorting to carrying an event monitor which is available from your doctor or cardiologist.
The other most common reason for similar sensations is from spasm of the esophageal (or swallow tube) muscles. It is usually managed conservatively with medications other than heart drugs. Often, esophageal spasm is associated with inflammatory or acid secretory conditions. If you have this, you will want to seek a gastroenterology specialty consultation to exclude serious underlying conditions that can be easily managed and/or diagnosed by upper gastrointestinal endoscopic evaluation.
Doctors will often elect to treat for reflux conditions first before evaluating every case by endoscopic esophageal and gastric evaluation. The most common medications used here are proton pump inhibitors that act by blocking gastric acid secretion. This is just a start for you, and it is important you know that other conditions can cause these symptoms. Be sure to follow through with a thorough evaluation until an appropriate treatment plan is successful in managing your symptoms and, hopefully, resolving them.

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