Dear Dr. Joshua
I am a 41 year old woman. I do not smoke, or drink. I do have severe asthma. I do have high cholesterol. I am trying to control it with diet. I have noticed lately, which means for the past month that my heartbeat seems to be “different”. I notice this most when I am at rest such as lying in bed, resting quietly, driving, or sitting at my computer. I don’t notice it when I am really active. It seems that as my heart beats, it pauses, and then it has an extra hard beat, it’s as if I am being punched from the inside. Then the regular beat starts, and then the pause and hard hit. I do not experience any pain associated with this. I take medicines for my asthma, such as albuterol, which does quicken the heartbeat but that is all I experience with that.

Dr. Joshua’s Answer:

This not an uncommon complaint, and your description matches the classic symptoms of extrasystolia, which means that the heart occasionally beats a moment before it should, and then it skips one beat, resulting in that pause you mentioned, after which the normal beat feels harder than usual. Irregular heartbeats of this type are called “extras” in medical jargon. They seem to be more common in females. Normally we are not aware of our heart beating. Extras result in what we call “palpitation” - awareness of the heartbeat.

Stress, coffee, alcohol and fatigue increase the incidence of extras.

These extras typically occur during rest and low activity, and as such they are harmless and not dangerous. There is no risk of the heart stopping or anything like that.

The recommended approach is to see the doctor, have a history and physical examination done, blood pressure measured, plus an EKG done. If everything seems normal, there is no need for further examinations. If these extras cause too much discomfort or worry, your doctor may prescribe a beta blocker to be taken in the evenings to prevent these from occurring.

If these extras or any other heart rhythm disturbances occur during physical activity and exertion, prompt further examinations are needed.

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