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Double and skipped heart beats during rest
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I was wondering if anyone has experienced something similar before and if it was a one time thing and what it could mean.

Last night when going to bed I could feel my heart beat (I almost always can, especially when focusing on it) and it was not consistent. I would have about 5-6 normal beats at regular spaced intervals, then followed by a double beat, followed by a pause, followed by a few normal beats and then the cycle would repeat itself.

At first I thought it was an artifact from laying in a strange position maybe - so I felt my veins in the neck and later on the wrist and it was the same thing. I used an app on my phone intended to measure heart rate via optical sensor, which also displays the optical response of the finger, and also there I could see the same pattern - regular beats followed by a double beat and then a short pause.

Yesterday was a rather hard training day (training has been a struggle the whole week) but I felt healthy otherwise with no symptoms of anything unusual. I would never have known the HR rhythm was off had I not felt it accidentally. This morning (or now) the rhythm is steady, showing normal beats and no hesitations or double beats.

Any thoughts? Google says it's probably something common and unlikely to be of concern but I'm keeping my eye on it anyways, but was wondering if anyone has experienced something similar.
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Re: Double and skipped heart beats during rest [Benv] [ In reply to ]
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What's your caffeine intake?

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Re: Double and skipped heart beats during rest [klehner] [ In reply to ]
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klehner wrote:
What's your caffeine intake?
Typically coffee 3 x per day but I don't know how much caffeine is in my coffee. Also, I read something about electrolyte imbalance (not sure if that means too much or not enough or wrong ratios) but I drank 7 bottles with 6 scoops of 1st endurance EFS Pro (which has tons of electrolytes).
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Re: Double and skipped heart beats during rest [Benv] [ In reply to ]
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Benv wrote:
klehner wrote:
What's your caffeine intake?
Typically coffee 3 x per day but I don't know how much caffeine is in my coffee. Also, I read something about electrolyte imbalance (not sure if that means too much or not enough or wrong ratios) but I drank 7 bottles with 6 scoops of 1st endurance EFS Pro (which has tons of electrolytes).

I've had something similar (premature ventricular contraction or PVC) but it was only when my electrolytes were off, specifically potassium which is vital for heart function. I eat a couple of bananas and it goes away (and I hate bananas). Give that a try and see if it helps.
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Re: Double and skipped heart beats during rest [Benv] [ In reply to ]
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I had the same thing for awhile and it’s definielty not a good feeling. As someone mentioned, it was PVC I believe. My head would send electrical signals from a different direction and that would cause a skip in beats, and then a hard beat after to “catch up” and cause thag pulsing feeling. I cut down my coffee intake and tried to get some extra sleep. No longer having afternoon coffee and just doing half caffeinated in the morning.

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Re: Double and skipped heart beats during rest [Benv] [ In reply to ]
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You most likely had a PVC with a compensatory pause in technical terms. See the following image. Essentially your heart contracts, top to bottom, atrium => ventricles. In this case it did that, then you had a contraction that started in the bottom and went to the top, ventricle => atrium (that double beat you feel). Since you normally feel the ventricles contracts (and not the atrium so much), that pause was essentially the delay after the ventricle contraction although likely your atrium (sa node and master governor of heart rate) stuck to its normal rate and never missed a beat although because you can't feel the atrium again it feels like a pause.

PVCs are benign for the most part, but as other posters said, caffeine, stress, hard workouts could bring them on. Interesting feedback on the optical. I still can't trust optical devices measuring HR and I still prefer interrupting the EKG strip myself. Maybe it just the geek in me or maybe it is the background in Pacemakers/Defibrillators, regardless, I use a device myself for AFIB patients that show me an EKG and I interrupt it myself. I don't have AFIB, they just make the best device I have found. It is called AliveCor if you really like to geek out on this stuff.


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Re: Double and skipped heart beats during rest [Thomas Gerlach] [ In reply to ]
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Thanks for the info! What do you mean with "interrupting" an EKG? Did you mean interpreting or something different? I have only a minor understanding of the different waveforms (worked on an EKG 'patch' a few years ago but as a materials scientist i was focusing in trying to collect clean data without motion artifacts rather than knowing what the waveforms really meant. Kinda wish I had some prototypes to play with still (I no longer work at that company).
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Re: Double and skipped heart beats during rest [Benv] [ In reply to ]
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Hey Benv, don't be the guy that doesn't get out of the swim or inexplicably crashes on the bike or collapses in the finishing chute because you read somewhere that what you had was "whatever". See your Doc and get a proper ekg (ecg) and tell him/her your story.
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Re: Double and skipped heart beats during rest [Benv] [ In reply to ]
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Hello Benv and All,

I was tracked for several years for PVC and it was not a problem or consideration for training and racing.

My doctor recommended exercise EKG (ECG) at about 2 or 3 year intervals to monitor heart functions.

I also have echo cardiograms at 4 year of so intervals to monitor heart valve condition and function .... just had one a few days ago and so far unremarkable.

The PVC was difficult to document initially as it only happened occasionally.

(A Premature Ventricular Contraction signal looks like 2 beats close together on the EKG plot but functions as a pulse skip)

I first noticed it on cool down from running and thought it was an artifact of my chest strap .. but old fashioned feeling pulse at wrist confirmed it was real.

I wore a 24/7 holter recorder for continuous 30 day tests a few times before capturing an event.

My resting HR was around 42 sometimes a bit lower ... and missing a pulse is noticeable at slower heart rates ... not so noticeable at higher heart rates and in fact did not happen on my EKG at higher heart rates.

Eventually at age 83 I needed a pacemaker because I would get 2 pulse skips in a row and feel faint .... and on one occasion briefly passed out. (One pulse skip was not a problem.)

Pacemaker works transparently now limiting my resting HR to 50 minimum with no restrictions (or 'blood thinner') for training or racing.

Heart is slightly enlarged which is normal for endurance exercise participants and likely has some scar tissue which also goes with the endurance exercise .... and the scar tissue can be the proximate cause of the heart nerve signal problems.

Maximum heart rate has slowly become lower with age and now is around 163.

Cheers, Neal

+1 mph Faster
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Re: Double and skipped heart beats during rest [nealhe] [ In reply to ]
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We are all assuming that it is a PVC and not an atrial premature beat, PAF, another type of arrhythmia including congenital QT syndrome, a drug interaction or any of a hundred other things. We don't know anything medically about Benv. The very people that are trying to reassure you are those least able to really help you. It would be a particular disaster if you took all this well meaning advice (and I realise it is really well meaning and could well be true) and didn't get checked out.
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Re: Double and skipped heart beats during rest [Mark57] [ In reply to ]
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Hello Mark57 and All,

You are correct .... with heart problems or heart weirdness .... see a doctor.

I should have emphasized that .....

Cheers, Neal

+1 mph Faster
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Re: Double and skipped heart beats during rest [nealhe] [ In reply to ]
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Thanks
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Re: Double and skipped heart beats during rest [Mark57] [ In reply to ]
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Mark57 wrote:
We are all assuming that it is a PVC and not an atrial premature beat, PAF, another type of arrhythmia including congenital QT syndrome, a drug interaction or any of a hundred other things. We don't know anything medically about Benv. The very people that are trying to reassure you are those least able to really help you. It would be a particular disaster if you took all this well meaning advice (and I realise it is really well meaning and could well be true) and didn't get checked out.
This is not the place for medical advice or diagnosis - that is very well understood and not the intention here. Let's say I was more curious about similar experiences and some insight and there are several posters that helped translate my description into more technical terms which is helpful by itself - either for my own understanding or to improve communication with a doc.
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Re: Double and skipped heart beats during rest [Benv] [ In reply to ]
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BTW this is from the optical iphone HR app yesterday: first 3 beats shown are normal and the next one is the double one (and the short pause right after). Again, it's optical at a finger, for whatever that's worth. I did it several times, always looked similar.

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Re: Double and skipped heart beats during rest [Benv] [ In reply to ]
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Benv wrote:
Thanks for the info! What do you mean with "interrupting" an EKG? Did you mean interpreting or something different? I have only a minor understanding of the different waveforms (worked on an EKG 'patch' a few years ago but as a materials scientist i was focusing in trying to collect clean data without motion artifacts rather than knowing what the waveforms really meant. Kinda wish I had some prototypes to play with still (I no longer work at that company).

I mean just looking at the electrical picture of the heart instead of a surrogate metric like optical. There are many different rhythms the heart can have. What we think of normal is not all that exist. The most common arrhythmias are aflutter and afib and if we all live long enough we are all certain to end up with some arrhythmia. This is total overkill, but if everyone here read Rapid Interruption of EKGs and monitored their heart (daily) with something like the AliveCor, I can almost guarantee with 100% certainly we will save a few people from life altering strokes with AFIB. As a bonus, our health care premiums would probably drastically fall as a pooled group. When you have afib it is really easy to throw a clot from the heart that ends up in the lungs or brain and early detection and blood thinners are key.

In your case I say you mostly likely have Sinus rhythm with Compensatory PVCs, but you could have Sinus Rhythm with PAC, or PJCs for that matter. It could have been a short bout of Afib/Flutter. The optical wouldn't know the difference as it is just looking at blood flow. An EKG tells you exactly how, when, where you heart is contracting and if you can interrupt (ie. read) the EKG then you can see exactly what is going on.


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Re: Double and skipped heart beats during rest [Thomas Gerlach] [ In reply to ]
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I’ve noticed this as well within the last 2-3 weeks. I’m making an appt with my PCP this week and will request a referral to a cardiologist/electrophysiologist most likely.

As another poster stated, don’t take internet advice for most medical issues, especially regarding your heart. Everyone means well but can only offer so much insight over the interweb.
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Re: Double and skipped heart beats during rest [Benv] [ In reply to ]
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Benv wrote:
BTW this is from the optical iphone HR app yesterday: first 3 beats shown are normal and the next one is the double one (and the short pause right after). Again, it's optical at a finger, for whatever that's worth. I did it several times, always looked similar.

And is it still happening or has it died down? Always good to get an official heart checkup and ekg, stress test, screen etc to get it sorted out but I do think there is a lot of power in being involved in your own health too. Of course this comes from someone who the next time he sees his ENT he is going to ask if they have an old Tympanometry device that he can borrow/buy from them. Nobody cares more about my own health than I do.


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Re: Double and skipped heart beats during rest [Thomas Gerlach] [ In reply to ]
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Thomas Gerlach wrote:
Benv wrote:
BTW this is from the optical iphone HR app yesterday: first 3 beats shown are normal and the next one is the double one (and the short pause right after). Again, it's optical at a finger, for whatever that's worth. I did it several times, always looked similar.


And is it still happening or has it died down? Always good to get an official heart checkup and ekg, stress test, screen etc to get it sorted out but I do think there is a lot of power in being involved in your own health too. Of course this comes from someone who the next time he sees his ENT he is going to ask if they have an old Tympanometry device that he can borrow/buy from them. Nobody cares more about my own health than I do.
Everything totally normal this morning and the 20 other times I checked during the day.

I'll be honest I'm not at all concerned given the various things that could play a role - like a hard IM training day including the first day of the year it was really hot; bad coffee habits, lots of work stress, and not noticing anything unusual otherwise. I'll keep checking but I don't think I will do anything else unless I notice it again.
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Re: Double and skipped heart beats during rest [Benv] [ In reply to ]
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I am a competitive cyclist and have PAC's. Went to a cardiologist, did Echo and holter moniter. I have no structural abnormalities and holter moniter showed they were not frequent enough to be of any concern. For me they come and go, sometimes nothing for a month and other times all day. The key things I have found that exscerbate the issue:

Caffeine
Alcohol
Poor sleep
Very high intensity training or long rides 6+ hours
Dehydration

Excess potassium is a known issue as well.
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Re: Double and skipped heart beats during rest [Benv] [ In reply to ]
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This sounds like what i had too, PVC. Get it checked out though by cardiologist. The things that contribute to mine are: stress, caffeine, sleep, (I would assume alcohol too, but don't really drink).

The MD's can tell from where in the heart your misfiring electrical signal comes from, to make sure it is not something like a-fib (a potential dangerous rhythm that can lead to bad things).

My biggest tip would be to get a sleep study or just buy a CPAP (Continuous positive airway pressure) machine with auto adjust setting. If your snoring, this is an indicator that your oxygen could be dropping at night and exacerbating PVC's (from my experience).


Good luck, hope this helps,



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Re: Double and skipped heart beats during rest [mfrassica] [ In reply to ]
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You didn't say how old you are, but there a bunch of 50 plus aged guys with funky heart beats. Go see a cardiologist. They may just do an ecg/ekg and figure it out, or you may get a holter monitor that is a 24hr ekg, stress treadmill, thallium treadmill, echo or a bunch of other stuff.
I never missed a beat until I was 60 now my diagnosis is pac and/or funky looking beats with occasional pvcs. When your resting heart rate is low and you have funny beats, you should probably carry a medalert card/ Come in unconscious and the ED thinks head injury or you may be having ekg problems.
My cardiologist just laughed at me after a ton of tests and said keep on doing what you are doing. Came with a lifetime guarantee mine or his. I do usually travel with an ekg copy and note from my cardiologist. Never had to use it but when I changed Primary Care docs he thanked me for bringing it in, saved him a bunch of time and me a bunch of money. Good luck and go see a doctor.
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Re: Double and skipped heart beats during rest [G-man] [ In reply to ]
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G-man wrote:
You didn't say how old you are, but there a bunch of 50 plus aged guys with funky heart beats. Go see a cardiologist. They may just do an ecg/ekg and figure it out, or you may get a holter monitor that is a 24hr ekg, stress treadmill, thallium treadmill, echo or a bunch of other stuff.
I never missed a beat until I was 60 now my diagnosis is pac and/or funky looking beats with occasional pvcs. When your resting heart rate is low and you have funny beats, you should probably carry a medalert card/ Come in unconscious and the ED thinks head injury or you may be having ekg problems.
My cardiologist just laughed at me after a ton of tests and said keep on doing what you are doing. Came with a lifetime guarantee mine or his. I do usually travel with an ekg copy and note from my cardiologist. Never had to use it but when I changed Primary Care docs he thanked me for bringing it in, saved him a bunch of time and me a bunch of money. Good luck and go see a doctor.

Not sure if this was intended the original poster. However, I will answer to help others who may find this info helpful.

I am a male in my mid 40's.

My PVC's were first noticed when I was in my teens when active in competitive rowing and become more aware of my heart rate. I never got it checked out until I was in my 30's in grad school when my PVC's were going on like crazy. The context was that I was dealing with thesis work, drinking coffee like crazy and terrible sleep, stress.

I got the full checkup, 12 lead EKG, nuclear stress test, O2 censor when sleeping, cardiologist appointments.... Was told my Oxygen was dropping just below 90% saturation, get more sleep, and that was about it.

Sometime in my early 40's I got a CPAP, and notice that my PVC are less often when used.
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