I have heart palpitations that feel like chest vobrations at night that continue for about a minute or two after waking and are followed by skipped heart beats for several hours afterwards.  The most noticable episodes occurr between 3 and 5 a.m. I an 74, male, exercise regularly, suspected of atherosclerosis.  Recently had a medical exam, ECG, Holter monitor which seemed to indicate no major abnormalities.
Hello and thank you for using Chat Doctor. I carefully read your question and I understand your concern. I will try to explain you and give my opinion. You should know that this skipped beat has to do with a rhythm issue. There are some electrical impulses that generates from parts of the heart different from normal sinus rhythm. They cause premature heart contraction that it's not a normal one followed by a pause, and you might experience a skipped beat, palpitations, difficulty in breathing deeply, anxiety. There are different causes of this rhythm issue like simple stress, coffee or energy Chat Doctor. You mention that you have already done a holder rhythm monitoring and it doesn't reveal anything abnormal. This is very good news. But you should know that this palpitation is sporadic episodes, and it is difficult to catch them. If I was your treating doctor I would insist on finding the cause and I would recommend a cardiac echo to evaluate heart function and valves, a full blood analyze to exclude anemia, hyperthyroidism and a street test as you say you are suspected for atherosclerosis. It is essential to exclude ischemic heart disease. After all this we can better judge what we are dealing with and if we should treat medical. Hope I was helpful. Best regards,