A. Definition
The word ‘‘palpitation’’ is used by doctors and by some patients to describe the heartbeat when it is fast, pound¬ing, skipping, or irregular. A patient posed the following question:
I am 28 and have a problem with a heartbeat pause. This problem comes and goes and may result in 5–10 pauses each minute. Sometimes my heart feels as if it makes an extra beat. If I lie down, the irregularity seems more pronounced. I went to my family doctor who found nothing wrong. My doctor concluded that these pauses were caused by too much adrenaline in the blood. Could you tell me more about this: the possible causes, cures, and long-term harm to the heart?
The question is answered as follows:
A heartbeat pause is due to an extra beat (extrasystole), medically termed a premature beat (see Fig. 1). Premature beats may originate in the top chamber of the heart. These are referred to as atrial premature beats, and they are of no significance if they occur in a normal heart. If they occur in the ventricle, they are called ventricular premature beats. Patients perceive the abnormal heart rhythm as either an extra beat or a pause. An individual may state: ‘‘My heart skipped a beat.’’ The extra heartbeat nearly always becomes more prominent when the heart slows while sitting or lying down. When the heart speeds up during walking or other activities, the extra beats are often suppressed by the normal beats. Movement of the body also prevents the sensation of the stronger heartbeat.

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