根據您的文章標題心跳忽然露拍後跳很大力和內容，建議您可以將其改為心悸且心跳強烈：初步診斷與治療建議。這樣可以更清楚地表達出您的問題，讓讀者更容易理解您的情況。-心臟血管專科

心跳忽然露拍後跳很大力？

醫師您好
最近有時會覺得心臟少跳一拍，後又跳得很大力
不管是靜態或動態時都發生過
有時會覺得頭暈，呼吸不順氣上不太來
本身有心臟病(開放性動脈導管、心律不整)
我去做過心超、24小時心電圖、運動心電圖、肺容量測試
這是我的報告
24小時心電圖(2份):
HOLTER EKG: 24小時動態心電圖(Holter EKG) 1. Basic rhythm: Sinus rhythm 2. Duration: 21 hrs 47 mins, total 83341 beats 　 3. Minimal heart rate: 39 bpm; sinus rhythm at 12:18 AM Maximal heart rate: 120 bpm; sinus rhythm at 08:45 AM Average heart rate: 64 bpm 4. Premature ventricular contraction: beats, burden: ％ type: single, 5. Premature atrial contraction: 24 beats, burden: ％ type: single, couplet APC 6. Tachyarrhythmia: Yes: Pattern 1: short—run SVT consecutive 9 beats at 11:15 AM Pattern 2: Pattern 3: 7. Bradyarrhythmia: No 8. Atrioventricular conduction block: No 9. Pause ＞ 2 seconds: No 10. Dynamic ST change: No 11. Other findings: ============================================================================ = Conclusion: short—run of SVT ============================================================================ = Abbreviations: AF=atrial fibrillation, AFL=atrial flutter, AT=atrial tachycardia, AVB=atrioventricular block, SVT=supraventricular tachycardia, SVR=slow ventricular rate, RVR=rapid ventricular rate, VT=ventricular tachycardia

Holter’s ECG Report: 1.An ambulatory Holter recording was started on 2025／3／12 03:09:32 with a duration of 24:00:03 hours. 23:57:50 hours were used for analysis. The average heart rate was 73 bpm during the day, 51 bpm at night and 65 bpm over the complete recording. The maximum heart rate was 128 bpm at 10:24:25. The minimum heart rate was 38 bpm at 04:36:40. 2.No definite VENTRICULAR ECTOPIC ACTIVITY was present. 3.SUPRAVENTRICULAR ECTOPIC ACTIVITY was present. Few Isolated SV ectopics were present. 4.Clinical correlation is advised.

運動心電圖:
Pulmonary function test Spirometry:FVC =4.68L;Predicted:108.30% FEV1 =4.38L;Predicted:120.70% FEV1／FVC:93.59% MVV =125.6L／min;Predicted:83.00% Comment: The PFT is within normal limits. Cardiopulmonary exercise test 24 y／omalePDA 173.1cm62.2 kg,BMI 20.8; 15 watt bicycle protocol Exercise for 9 min 00 sec,152W Terminated due to SOB and lower limb weakness. VO2 AT =4.1MET,HR =98 ／min, VE:20.8 L／min , RER:0.87, SPO2 =98% VO2 peak =9.1MET,HR =154 ／min, VE:61 L／min , RER:1.08, SPO2 =99% BP rest =137／79mmHg,HR =82 ／min BP max =218／97mmHg, Heart rate recovery (HRR) in 1 min: 9 VE／VCO2 slope =23.1 OUES =1.7VO2／WR slope =7.2ml／min／W PetCO2(mmHg) : REST =39, AT =43, MAX =41 O2 pulse(ml) :REST =7, MAX =13 VD／VT : REST =0.05 , MAX =0.10 EOV: Kremser(+), Leite(—), Sun(—), Ben—Dov(+) Comment:MAXIMAL AEROBIC ABILITY ABOUT 68% PREDICTED FUNCTIONAL AEROBIC IMPAIRMENT(FAI): 32 %, mild FAI ST depression ＞ 1 mm in ll, lll, Avf during recovery phase borg RPE scale 16—17 when maximal effort

肺容量測試:
Pulmonary function test Spirometry:FVC =4.68L;Predicted:108.30% FEV1 =4.38L;Predicted:120.70% FEV1／FVC:93.59% MVV =125.6L／min;Predicted:83.00% Comment: The PFT is within normal limits. Cardiopulmonary exercise test 24 y／omalePDA 173.1cm62.2 kg,BMI 20.8; 15 watt bicycle protocol Exercise for 9 min 00 sec,152W Terminated due to SOB and lower limb weakness. VO2 AT =4.1MET,HR =98 ／min, VE:20.8 L／min , RER:0.87, SPO2 =98% VO2 peak =9.1MET,HR =154 ／min, VE:61 L／min , RER:1.08, SPO2 =99% BP rest =137／79mmHg,HR =82 ／min BP max =218／97mmHg, Heart rate recovery (HRR) in 1 min: 9 VE／VCO2 slope =23.1 OUES =1.7VO2／WR slope =7.2ml／min／W PetCO2(mmHg) : REST =39, AT =43, MAX =41 O2 pulse(ml) :REST =7, MAX =13 VD／VT : REST =0.05 , MAX =0.10 EOV: Kremser(+), Leite(—), Sun(—), Ben—Dov(+) Comment:MAXIMAL AEROBIC ABILITY ABOUT 68% PREDICTED FUNCTIONAL AEROBIC IMPAIRMENT(FAI): 32 %, mild FAI ST depression ＞ 1 mm in ll, lll, Avf during recovery phase borg RPE scale 16—17 when maximal effort

心超(2份):
ECHO: 經胸前超音波(Transthoracic echocardiography) M—mode (Normal data) 1. Aorta／LA (23—37／18—38mm) 27 ／ 27 2. IVS／LVPW (6—12／ 5—11mm) 8 ／ 6 3. LV—Diamter Dias／Sys (36—52／20—36mm) 48 ／ 27 4. LVEDD／LVESD Volume (46—108／10—54ml) 105 ／ 28 5. LV SV／ EF (32—95ml／49—76%) 78 ／ 74 6. LVEF Simpson’s method (4—chamber view): %, study parameters(TSOC_HF): No 7. LVEF by 3D method A) Dilated heart size: None; Thickening: None B) Pericardial effusion: No, Tamponade: No C) Intracardiac mass／thrombus: No D) Mitral flow pattern:, E:, A:, DT: E) Tissue Doppler Velocity: Sep e’:, E／e’:, Lat e’:, E／e’: F) Valve lesion: *AV: normal — AS: —／4, AVA:cm2, mean PG:mmHg, peak PG:mmHg — AR: —／4, VCW:mm, P1／2t:ms *MV: normal — MS: —／4, MVA:cm2, mean PG:mmHg — MR: —／4, VCW:mm, jet: *TV: normal — TS: —／4, TVA:cm2, mean PG:mmHg — TR: —／4, PG: mmHg, VCW:mm *PV: normal — PS: —／4, mean PG:mmHg, peak PG:mmHg — PR: —／4 (1:trivial, 2:mild, 3:moderate, 4:severe, 5:massive, 6:torrential) G) Congenital lesion: None H) LV wall motion: Normal I) Global LV performance: adequate J) Global RV performance: adequate, TAPSE: mm K) LV diastolic function: , criteria: L) Other findings: M) 2D—Echo Machine: N) 住院病人ISBAR交班: No ============================================================================ == #Conclusion: normal LV systolic and diastolic function ============================================================================ == Ao=aortic root, AR=aortic regurgitation, AS=aortic stenosis, AT=acceleration time, DVI=doppler velocity index, EF=ejection fraction, EOA=effective orifice area, ET=ejection time, HCVD=hypertensive cardiovascular disease, IVC=inferior vena cava, IVS=interventricular septum, LA=left atrium, LV=left ventricle, LVPW=left ventricular posterior wall, MR=mitral regurgitation, MS=mitral stenosis, PR=pulmonary regurgitation, PS=pulmonary stenosis, PG=pressure gradient, RA=right atrium, RV=right ventricle, TR=tricuspid regurgitation, TS=tricuspid stenosis, TAPSE=Tricuspid annular plane systolic excursion, VCW=vena contracta width.

CLINICAL RECORD OF ECHOCARDIOGRAPHIC EXAMINATION 1. Structure: (1) Cardiac Situs : Normal Atrium : Normal Ventricle : Normal AV junction : Normal Great Arteries: PDA s／p coil,with no r—PDA Arch : Normal (2) Others: 2. Measurements: M—Mode: LVIDd／s(cm)= 4.52 ／ 3.05 , AO／LA = 2.8 ／ 3.5 cm RV: cm EF: 61.0 % FS: 32.5 % Other: 2—D: (size: cm) (size: cm) PA／AO: ／ cm Other: Doppler: AR: m／s, AO: 1.64 m／s PR: m／s, PA: 1.29 m／s MR: m／s, MS: m／s TR: m／s, TS: m／s Others: 3. Diagnosis: PDA s／p coil,with no r—PDA preserved cardiac function

請問醫師我是續觀察即可還是需要做甚麼治療呢?謝謝您

阿伶，20~29歲男性，詢問日期：2026/01/01

吳學明醫師回覆-心臟血管專科

醫事人員經歷：衛生福利部桃園醫院心臟內科主任、臨床技能中心主任

24小時心電圖顯示有心律不整的現象，建議您如果症狀頻繁發生，請到門診與醫師討論藥物的治療。

回覆日期：2026/01/01
資料來源：台灣e院 - 心跳忽然露拍後跳很大力

彙整補充說明

根據您所描述的症狀，您經常感受到心臟的心悸與心跳強烈，並且伴隨有漏拍的情況，這可能與您的心臟病史有關。
您提到的心臟病（開放性動脈導管及心律不整）以及之前的檢查報告顯示的心律不整，都是需要特別注意的因素。

首先，心悸（palpitations）是許多人都會經歷的現象，通常是由於心臟的電傳導系統出現了短暫的異常，導致心臟的跳動變得不規則或強烈。
這種情況可能是由多種因素引起的，包括情緒壓力、咖啡因攝取過多、缺乏睡眠、或是某些藥物的副作用等。
對於有心臟病史的人來說，心悸的原因可能更為複雜，且需要更謹慎的評估。

根據您的檢查報告，24小時心電圖顯示您有短暫的心房或心室早期收縮（premature contractions），這在某些情況下是良性的，但如果伴隨有其他症狀，如暈眩或呼吸困難，則需要進一步的檢查。
您提到的心跳突然加速及漏拍的情況，可能是由於心臟的自律神經系統失調，或是心臟本身的結構或功能異常所導致。

在這種情況下，建議您持續觀察自己的症狀，並記錄發作的頻率、持續時間及伴隨的其他症狀（如頭暈、呼吸困難等）。
如果症狀持續或加重，建議您儘快就醫，尋求心臟科醫師的專業意見。
醫師可能會建議進一步的檢查，例如心臟超音波、運動心電圖或是更長時間的心電圖監測，以便更全面地了解您的心臟狀況。

此外，對於心悸的管理，您可以考慮以下幾點：
1. 生活方式調整：保持規律的作息，避免過度疲勞，並減少咖啡因及酒精的攝取。
適度的運動有助於改善心臟健康，但要根據自身的狀況選擇合適的運動強度。

2. 情緒管理：壓力和焦慮可能會加重心悸的情況，您可以考慮練習放鬆技巧，如深呼吸、冥想或瑜伽等。

3. 定期檢查：由於您有心臟病史，定期的心臟檢查是必要的，這樣可以及早發現潛在的問題。

總之，您的症狀需要謹慎對待，特別是考慮到您的心臟病史。
建議您與心臟科醫師保持良好的溝通，並根據醫師的建議進行必要的檢查與治療。
希望您能早日恢復健康！