Brief Answer:
NO - mostly benign

Detailed Answer:
Hi friend
Welcome to Health Care Magic

Feeling of ‘dropping- skipping- missed- hard- fluttering-’ beat is called ECTOPIC or premature beats / palpitation and so on. The rate may be fast or slow / the rhythm may be irregular / it may be felt in the chest, neck, or stomach. Dysrhythmia (Arrhythmia) is commonly used) is the name.

A beat comes earlier than normal – this itself is not usually felt. The next beat is a bit delayed - longer time to recover from early extra beat – so heart fills more and the beat appears forcible – thud / lubb - - dubb - - lubb - - dubb - lub - - - DUBB /

Ectopic beats can arise from ventricle (lower chamber of the heart - Ventricular Ectopic; VPC) or Atrium (upper chamber - Atrial Ectopic; APC).
APCs are generally harmless. Even VPCs are often harmless – ‘benign’.
If they are frequent - more than 5 per hour, 2 or more beats coming consecutively – they should be investigated further.

The first step is to see a Cardiologist. A thorough history and physical examination is the first step -
Irregular heartbeats need to be DOCUMENTED by ElectroCardioGram (EKG). Standard ECG records the electrical activity of the heart, for a few seconds. It can detect the arrhythmia occurring during that time only. If the episode occurs randomly or is precipitated by a specific activity like exercise - one needs Holter or event monitor.

Anaemia / Anxiety / Alcohol / Tobacco (smoking) / Caffeine (too much tea, coffee, cola) / Fever / Infection / Pain / Stress / Thyroid / Electrolytes like calcium, magnesium and so on – are some of the usual causes / At times, abnormal nerve paths in the heart (bypass tracts) or disease of the conduction system may be responsible!

These beats are common and often may be normal.
Yet it is advisable to have it investigated.
     ECHOcardiogram is necessary to see the heart valves (Mitral Valve Prolapse) / heart muscle (Cardiomyopathy) and heart function (Ejection fraction, wall motion abnormality) / clots...
      TMT – Treadmill exercise ECG; may be with thallium isotope – may be done to evaluate ischemia (reduced blood flow / Coronary Artery Disease)
     If there are no clues and if the problem is still bothering to the extent of interfering with life style, there are advanced investigations – Electro Physiological Studies (EPS) > it resembles angio – a catheter is put inside the heart / electrical activity recorded / stimulation and suppression tests are carried out / suitable medicine tested and so on. Though the test is the gold standard, it is INVASIVE and hence is not generally done unless there are compelling indications. This super-speciality expert is called ELECTRO-PHYSIOLOGIST.
The treating doctor may suggest them depending on need, based on his assessment of the situation.

     Many cases of palpitation are benign, especially when associated with normal ECHO and may not require treatment, If you also have symptoms like blurred vision, dizziness, loss of consciousness, shortness of breath, chest pain along with this, you need urgent work up
     The first line medicine is generally beta blockers, like Metoprolol. You are already taking REVELOL AM, which contains Metoprolol and amlodipine. The dose of Metoprolol is up to 200 mg in some and your doctor may adjust the dose

Good luck
God bless you

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