This gymnast didn't mean to give everyone a heart attack

'I think I gave everyone out there a heart attack'

'I apologise. I won't do that again'

Two falls on an 'off day' did not prevent Simone Biles from becoming the first woman to win four all-around titles at the gymnastics world championships on Thursday.

Despite falls on the vault and balance beam, the American still finished with 57.491 points in Doha to add to the titles she won in 2013, 2014 and 2015.

Less than a week after visiting a hospital emergency room with a kidney stone that is yet to pass, Biles did not use the condition as a reason for her 'disappointing' day.

“This one has probably been the hardest to get out of all my world championships and Olympic medals, and the scariest one,” Biles said.

“It’s exciting to bring back a gold medal for the US, but for me it’s a bit disappointing because that’s not the performance I would hope to give.”

The 21-year-old took more than a year off after winning four gold medals, including the all-around, at the 2016 Rio Olympics.

"Didn't mean to give everyone a heart attack," she tweeted of her mistakes afterwards. "I apologise. I won't do that again."

“Even the best fall sometimes, but I’m excited that I pulled it out at the end. I was definitely shocked.”