<s>[INST] Hi doctor, I am 21 years old and having regular single heart palpations. I have an Apple Watch which provides an ECG and this shows my heart is beating at regular intervals, but there is fairly regularly a single beat which is much larger. I can feel this in my stomach/chest area and feels like a heavy beat or a missed beat. I will upload a couple of PDF results to show you. You can quite clearly see when these large beats take place. I sometimes get chest pain but I usually attribute this to my stomach or anxiety, and the chest pain does not tend to accompany the heart palpitation. My main worry is it is quite regularly happening and it is one singular beat which is ‘off’. I have bad bloating which has been for the last month or two which comes and goes, but am unsure if this is related. [/INST] Hello. I have gone through the results you attached (attachment removed to protect patient identity). You are experiencing missed beats aslo known as premature ventricular contractions. They are are usually benign (harmless). Your symptoms can be worsened by drinking, caffeine, smoking or some medications. I usually do not prescribe my patients medication at first except it affects your daily activity. Firstly, avoid trigerrs like alcohol, drugs, sleeplessness, etc. Try to exercise regularly. Atleast 3 or 4 times a week. For a duration of 30 minutes. Make sure to sleep 6 to 7 hours daily at night. If your symptoms persist, you will need a Beta-Blocker medication. It acts by regulating how your heart beats. Ablation is the definite treatment of choice if all measures fail but am hopeful it will not get to that. I wish you good health. Best regards. </s>