For most adults, a normal heart rate is 60-100 at rest. This can increase during exercise, anxiety
, fever, or pain in order to deliver more oxygen to your muscles and other organs. During this, your heart typically remains in the same rhythm but simply increases its rate. However, a sensation of a sudden missed beat followed by a rapid heart rate may indicate an arrhythmia, and I recommend further evaluation by your physician.
Several common arrhythmias include atrial fibrillation, atrial flutter, atrioventricular reciprocating tachycardia, AV nodal reentrant tachycardia, or atrial tachycardia. It is also possible you are sensing premature atrial or ventricular complexes, which are essentially early heart beats that originate outside the heart's normal electrical system. These are extremely common and typically benign. However, if they are extremely frequent, they can lead to an abnormality in your heart's pumping capacity. More rarely, you could suffer an arrhythmia that originates in the ventricles, or lower chambers of the heart, such as ventricular tachycardia. Given that you are symptomatic from these episodes, I recommend you discuss this further with your doctor
. A typical evaluation consists of a thorough history and physical examination and EKG. Depending on these results, you may require 24-hour EKG monitoring or an event monitor, which is a device you place on your chest during symptomatic episodes to record the rhythm. Also possible tests include an echocardiogram (ultrasound of your heart) to look for structural heart disease or an exercise treadmill test to see if this can induce the arrhythmia. Again, it is important to discuss your symptoms further with your primary care physician
to determine the next appropriate steps in your evaluation.