Why Do My Palpitations Feel Like My Heart Is ‘Skipping’ or ‘Thumping’? 

The sensation of the heart ‘skipping’ a beat or landing a heavy ‘thump’ against the ribcage is one of the most common reasons patients seek medical advice. It can be a frightening experience, often feeling as though the heart has stopped momentarily. However, these sensations are rarely caused by the heart stopping. Instead, they are the result of a fascinating physiological chain reaction involving the heart’s electrical timing and blood volume. 

What We’ll Discuss in This Article 

• The mechanical reason for the ‘skipped beat’ sensation 

• Why the beat following a skip feels so powerful (the ‘thump’) 

• The role of the heart’s electrical reset (compensatory pause) 

• How the Frank-Starling Law explains forceful heartbeats 

• Why these sensations are often more noticeable at night 

• When a thumping heart requires medical investigation 

• Emergency guidance for associated chest pain 

The Electrical Pause That Creates the Sensation of a Skipped Beat 

The sensation of a ‘skipped beat’ is usually caused by a pause in the heart rhythm known as a ‘compensatory pause’. This occurs after an ectopic (premature) beat fires too early. Because the premature beat is often too weak to be felt, you only notice the silence that follows it while the heart’s electrical system resets itself. 

Essentially, the ‘skip’ is an electrical reset period. 

1. Premature Fire: An early electrical signal causes the heart to squeeze before it is full of blood. 

2. No Pulse: Because it wasn’t full, very little blood is pumped out. You don’t feel a pulse beat for this contraction. 

3. The Wait: The heart’s natural pacemaker (sinus node) has to wait for its turn to fire again. This creates a momentary silence or ‘void’ in the rhythm. 

4. The Sensation: Your brain registers this silence as a missed beat. 

Why the Recovery Beat Feels Like a Powerful Thump? 

The heavy ‘thump’ or ‘kick’ that follows the skip is physically real. During the long pause, the heart fills with much more blood than usual. To pump this extra blood out, the heart muscle stretches and contracts with significantly more force than a normal beat. This phenomenon is known medically as ‘post-extrasystolic potentiation’. 

This mechanism is governed by the Frank-Starling Law of the Heart, which states that the more the heart muscle is stretched by incoming blood, the more forcefully it will contract. 

The table below breaks down the sequence: 

Stage	What Happens Physically	What You Feel
1. Ectopic Beat	Heart contracts early and weak.	usually nothing (or a slight flutter).
2. Compensatory Pause	Heart relaxes for longer than usual; fills with extra blood.	A sensation of the heart stopping or a ‘void’.
3. Recovery Beat	Heart muscle is stretched; contracts violently to eject the extra volume.	A massive ‘THUD’ or ‘KICK’ in the chest.
4. Normal Rhythm	Blood volume returns to normal.	Rhythm returns to steady ticking.

Common Triggers for Thumping Sensations 

While the mechanism is mechanical, certain external factors can make the thumping sensation feel more violent. High levels of adrenaline or a hyper-aware nervous system can amplify the feeling of the heart beating against the chest wall. 

Factors amplifying the thump: 

• Adrenaline: Increases the contractility (squeeze force) of the heart muscle, making every beat harder, not just the recovery beat. 

• Lying Down: When lying flat or on the left side, the heart is closer to the ribs, transmitting the sound and vibration more clearly. 

• Thin Body Habitus: People with less body fat or muscle over the chest wall tend to feel internal organ movements more acutely. 

• Anxiety: Causes ‘hypersensitivity’, where the brain interprets normal bodily signals as dangerously loud or strong. 

Differentiation: Anxiety Thumps vs. Ectopic Thumps 

It is important to distinguish between the continuous pounding of anxiety and the isolated thump of an ectopic beat. Anxiety usually causes a sustained fast, heavy heartbeat, whereas ectopic beats cause a momentary interruption followed by a single heavy thud. 

The following table compares the two experiences: 

Feature	Anxiety/Panic	Ectopic Beats
Rhythm	Fast but regular (like a racing engine).	Regular with sudden interruptions (like a hiccup).
Duration	Sustained pounding for minutes or hours.	Instantaneous thud, over in a second.
Trigger	Stressful thought, worry, or panic attack.	Can happen when completely relaxed or asleep.
Pattern	‘Thump-Thump-Thump-Thump’ (continuous).	‘Tick… Tick… [Silence]… THUD… Tick’.

Conclusion 

The sensation of skipping and thumping is a mechanical reality, not just a figment of imagination. The ‘skip’ is the heart waiting to reset after a misfire, and the ‘thump’ is the heart working harder to clear the backlog of blood accumulated during that wait. While this feels violent and alarming, in a structurally healthy heart, it is an efficient and safe way for the body to maintain blood flow. However, if these thumps are accompanied by pain or breathlessness, medical assessment is required. 

If you experience severe, sudden, or worsening symptoms, such as chest pain, fainting, or severe breathlessness, call 999 immediately. 

Authority Snapshot 

This article was reviewed by Dr. Rebecca Fernandez, a UK-trained physician with extensive experience in cardiology, internal medicine, and emergency medicine. Dr. Fernandez holds an MBBS and has managed critically ill patients as well as providing comprehensive inpatient and outpatient care. This guide provides medically safe, evidence-based information explaining the physiological mechanisms behind the ‘skipping’ and ‘thumping’ sensations of heart palpitations.