Why skipped heartbeats always seem to happen at the same point in your menstrual cycle.

For those articles where there’s such overwhelming study findings that I feel comfortable presenting information as fact, I won’t put a “byline” picture at the top of the article.

You’ll see there’s a byline picture on this article. And with that byline I’m hoping you’ll let me express some frustration with the medical community. Palpitations, PVCs, PACs and other various arrhythmia are suffered by a huge portion of the population. Huge. And there are thousands upon thousands of pages on the web of women suffering through arrhythmia that seems to coincide with their cycles, and nobody’s able to provide them with a straight answer for why it happens.

The medical community just collectively pats women on the head, says “everything will be ok,” then sends them on their way. And nobody’s ever made to understand WHY this is happening. I even read an article by the female director of women’s cardiovascular health at University of Pennsylvania. ^[1] I mean, you can’t even dream up a better resource, right? She provided responses no better than you’d find at Yahoo! Answers.

Why is there no science on this topic? Why no studies? The results of those studies and presenting the science in lay terms would probably add hundreds of thousands of productive hours back into the lives of women across the world, instead of having them take time away from career or family, either at a doctor’s office or just withdrawing from the world for fear of dying of cardiac arrest.

That seems worth the effort and expense of a single study and comprehensive, scientific breakdown.

But we don’t have that. So I’ve gone over, under and through the web to find and piece together as much information about female menstrual cycles and causes for arrhythmia. The results of that research I present here. I hope it can give you some degree of peace.

Before I get too deep into how a woman’s menstrual cycle might affect heart rhythm, I think it’d be worthwhile to have a refresher on how it is, exactly, that a heart is able to beat. Just like every other muscle cell in your body (arms, legs), each cell in your heart holds a tiny little electrochemical charge (think of your car battery and the sloshy fluids inside it - same sort of thing). When that cell is ready to discharge, it becomes permeable by other electrolytes (like sodium ions (Na+)). When those electrolytes rush into the newly permeable cells, it starts an electrochemical chain reaction, moving from cell to cell to cell, resulting in the coordinated contraction of the muscles in your heart, squeezing to pump blood to the rest of your body.

That’s how your heart works. And I feel more than a little ridiculous, being a man, about to explain how the menstrual cycle works. But here I am, doing it anyway. At least a part of it.

As the female body performs it’s monthly task of preparing for pregnancy, making conditions optimal for creating a baby, then purging all evidence of that preparation (only to do it all over again the next month), hormones are coursing through a woman’s veins. During the first phase (of two) in the cycle, the follicular phase, the level of estrogen in the body is increased up until the point that it peaks, at ovulation. Post-ovulation, the amount of estrogen in the body decreases. Part of the reason that occurs is because the estrogen did it’s job: it initiated ovulation. The other part of the reason estrogen levels decrease is because (as is hypothesized by some in the medical profession), progesterone levels in the body increase just prior to ovulation, peaking in about the middle of the luteal phase (second phase) of the menstrual cycle. The theory is this: progesterone aids the body in metabolizing excess estrogen or as an antagonist to it’s production ^[2], so as progesterone levels increase, estrogen levels decrease. (I should note that the graphic here, courtesy of Wikipedia, seems to counterindicate that relationship between progesterone and estrogen levels. But for this discussion about heart rhythm, it isn’t relevant, so I won’t do anything beyond mentioning that I question the validity of the hypothesis about metabolizing estrogen with progesterone.)

And every month, this hormonal battle is waged within a woman’s body.

So. How does this relate to heart rhythm and palpitations? It wasn’t until I found a power point presentation on the American Heart Association’s website discussing the use of progesterone as a possible treatment for Long QT Syndrome (LQTS) that I was able to find other data points and start putting a few pieces together.^[3]

According to Cardiovascular Research, a magazine of the European Society of Cardiology, women have a slightly longer QT interval than men when corrected for heart rate (QTc), which is to say that women also have a slightly higher heart rate than men.^[4]

The article stated that for women at risk of suffering an episode of torsades de pointes (a type of extremely dangerous ventricular tachycardia), those episodes almost never happened during the luteal phase of the menstrual cycle, suggesting a tie between progesterone and the rate of repolarization of ventricular heart cells. As a refresher, if ventricle cells are slow to repolarize (regain their electrical charge), they may not be ready to initiate muscle contraction when needed, meaning blood pushed into them from the atria doesn’t get pushed from the ventricles into the body in a timely fashion. Also, it can result in ventricle cells being asked to depolarize (begin the process of contraction) right at the moment they are repolarizing - this is what can initiate torsades de pointes, which can turn into ventricular fibrillation, which is deadly without medical intervention.

But I don’t mention all that to scare you. Torsades is extremely rare, and is more common in heart attack survivors than the general population (because of the electrical problems associated with the tissue death that accompanies a heart attack), and also tends to be hereditary. I only mention it to show that the effect of progesterone on the cardiac system of the female body has been investigated.

In other studies there was indication that progesterone enhanced action potential adaptation during rapid heart rates.^[3][5] In English? A woman’s tiny batteries in each heart muscle cell recharged faster in the presence of progesterone. Again, the study was relative to the problems associated with Long QT Syndrome, something that in all likelihood most all readers of this article do NOT have.

But the relevant part in my mind is that repolarization happened more quickly, making each of those heart cells ready to discharge and initiate a contraction earlier. If some of those cells are already predisposed to discharging early due to having a lower electrochemical threshold (the permeability I mentioned earlier), then those cells are just sitting there, all charged up, ready to set off a PVC, and they have an itchy trigger finger.

The result? A woman potentially getting more PVCs and palpitations during certain parts of her monthly cycle, every cycle. And for women who are taking birth control pills, this is likely to be exaggerated due to the increase in hormone levels from ingesting the pills.

Because there can literally be a hundred different reasons why a person experiences skips and flutters, the monthly increase in progesterone might not always be enough to cause skipped heartbeats. Maybe that month the person is under less stress and there’s been a lower quantity of catecholemines (a stress hormone) flowing through the body. Or other electrolytes are in better balance. Or she’s gotten enough sleep. Really, the reasons are too numerous to list.

But the doctors were right. Getting skips and bumps in your heart rhythm during the same part of your cycle is not an indication of anything sinister. In fact, it’s a sign that your reproductive system is working the way it’s supposed to, that progesterone is being produced, and that it’s making your heart a little jumpy. That’s all.

References

It gives you wings.^[1] It can give you seizures.^[2][3] Jim Carrey likes it. In 2008 the energy drink industry did $3 billion in sales in the United States alone, which is great if you need a late night pick-me-up to cram for exams.^[4] In a 2008 article in the Dutch Journal of Psychiatry, a significant increase in focus and sustained attention as well as reaction times was seen in subjects who had consumed energy drinks like Red Bull. ^[5]

But are energy drinks like Red Bull pro-arrhythmic?

You probably already know that energy drinks have a high concentration of caffeine and sugar (though “diet” versions are seeing increased popularity). Most also contain guarana in some form (which also contains caffeine) and taurine, an ingredient that drink makers claim can boost metabolism. ^[6] A few also contain bitter orange, a substance Kathleen Miller, a research scientist at the University at Buffalo’s Research Institute on Addictions, says is “very closely related” to ephedra.^[7] Ephedra was banned for sale as a diet supplement in 2004 because of findings that it caused blood pressure increases and otherwise stressed the circulatory system. ^[8]

Anecdotal evidence abounds over what these energy drinks can do to a person’s heart. In March of 2008, four middle school students in Broward County, Fla., went to the emergency room with heart palpitations and sweating after drinking the energy beverage Redline. ^[4] In September 2008 Chloe Leach, a 21 year old social work student in the UK, collapsed and died on a nightclub’s dance floor after consuming several Red Bull and alcohol. She suffered from borderline Long QT Syndrome. ^[9] In 2001 Ross Cooney, 18, from Ireland, died after he shared four cans of Red Bull then played basketball. ^[6] A 28 year-old motorcycle racer in Australia suffered cardiac arrest shortly after taking part in a grueling race. He’d consumed 7 cans of an energy drink prior to the race. ^[10]

These events are not all that surprising when you consider Henry Ford Hospital in Detroit, Michigan, published study findings in The Annals of Pharmacotherapy in March 2009 that showed an increased QT interval, a 10-point increase in blood pressure and an increase in heart rate of 5-7 beats per minute in healthy volunteers, from drinking 2 cans of an energy drink per day. ^[11] The hospital issued a warning that those with existing heart conditions avoid drinking energy drinks altogether.^[12]

And the danger multiplies when you add alcohol. Though alcohol depresses function of the central nervous system, it’s a heart stimulant. Enough so that the term “Holiday Heart Syndrome” was coined after a 1978 study of regular drinkers who engaged in binge drinking suffered cardiac arrhythmias, most often supraventricular tachycardia and paroxysmal atrial fibrillation. ^[13]

So if you’re a sufferer of the occasional heart palpitation or a more serious arrhythmia, it might be a good idea to cross energy drinks off your grocery list, especially if you’re a regular alcohol drinker (though you should probably cut back on that, too).

References

by Jeff

Back in 2006 I spent the better part of the year (from January until mid-November) with thousands upon thousands of PVCs a day.  My heart would skip a beat once every 5-6 beats, all day, every day.  Multiply that out (100,000 regular heartbeats per day on average) and you get around 5 million PVCs.

But here I am, 3 years later, having had exactly 80 “bad” days of PVCs since then, or just under 8% of my days since that awful period.*

How Did I [Nearly] Cure My PVCs?

To tell you how I did it, I need to take you along on my journey, beginning in September 2006.  Actually, it starts back in late 2005.  My company was building the waterfall pictured to the right as well as the surrounding landscape.  It was a big project for us and I knew going into it that I was making a deal with the devil taking on this project, the devil in this case being the general contractor.  We’d done work for him before and every time we did I swore we’d never work for him again.  But this was a big project with great visibility and we needed the business, so we took it on.  As could have been predicted, each day on that job site was like living in hell.

You’re probably wondering “Why is he talking about this waterfall?  I thought he was going to talk about his PVCs.”  For me, stress is the primary trigger for PVCs.  And this project was nothing if not stressful.  It started six months late, and when it was finally time for us to do our work, we were racing against the start of winter, battling freezing temperatures, a property owner who changed his mind daily and a general contractor who was pretty sure everyone was put on the earth to serve him.  And getting full payment out of him was nearly impossible.

About a week into the two month project, I noticed I was having quite a few PVCs.  Much more than usual, but nothing alarming.  We pushed through the project, miserable as I was, got paid most of our money and then closed up shop for the winter on November 22nd.

At that time we had a beautiful little one-year-old.  My wife, who had been the primary breadwinner for years, left her job in May that year to be a stay at home mom.  And 2005 was not a great year for the business, so money was tight.  Trying to figure out how all of our bills were going to get paid was not something we were accustomed to having to worry about, but were quickly getting initiated.

As the winter wore on, the funds dwindled and prospects for the 2006 construction season weren’t great.  Stress was ridiculously high.  I noticed that I was having near constant palpitations now, from the moment I woke up until I went to bed.  Every fifth or sixth beat, all day.  Every day.  I’d had PVCs that bad before, so I waited the usual week or two for my heart to settle down.

It never did.

The 2006 season started and we had to return to the waterfall project to do a few little things here and there.  And we had to fight to get paid.  I was already a wad of stress before the season started, and with the normally hectic pace of spring, fielding client calls, designing, selling and supervising construction, I just got stuck in a stress and PVC rut.

One good thing about the hectic pace of spring in a new construction season is that there just isn’t time to worry about things.  You’re just too busy to think of anything but the next task in front of you.  And so on it went through May, June, July and August.  I was always aware that I was having constant PVCs, but I was busy enough that I could just manage to push the worry out of my head enough to function.

But by September the work schedule was set for the remainder of the season and calls typically dwindle to a trickle, which gives me time to start focusing on other things.  My PVCs pushed themselves into my consciousness, front and center.  I was no longer able to ignore them and those fears - you know the ones I’m talking about - started making me afraid to do anything.  Afraid to live and afraid to die.  I started wondering if my little girl would have to grow up without her dad, and how my wife would get along without me.

I wallowed for weeks in depression and fear.

Then, like many of us do after PVCs make an uninvited, extended stay, I decided I wasn’t going to go down without at least a little fight.  I was going to do something.  Try something. Try anything to get these heart skips to stop.  I got on the computer and started researching everything and anything to do with reducing or eliminating irregular heart rhythms.

I cut out soda completely.  Regular, caffeine-free, diet - they were all off limits.  No more coffee.   I started cutting back on products with refined sugar.  I swore off chocolate.  But after a month I was still having as many ectopics as I had with the soda, sugar and chocolate.

I tried getting more sleep.  My sleep patterns had been terrible, especially since now we had a second child on the way.  I started drinking lemon balm tea.

I tried some methods of stress relief.  I stopped watching the news completely - nothing but doom and gloom coming out of that box.  I started unplugging from the world about an hour before bed, taking my time getting ready to go to sleep, then spending 30-40 minutes in bed every night reading a book.  This quickly became time I looked forward to, time that was nobody’s but my own, and I could just turn my brain over to the story being told on the pages in front of me and shut everything else out.

Three months later, my heart finally started to settle down.  Soon I’d have so few PVCs per day that I stopped counting the beats between the last and next palpitation.  I stopped taking my pulse.  I could finally start laughing again and enjoying time with my family.

Fast forward to 2009 - I still have flare-ups that are as bad as my worst days in 2006.  But those flare-ups stop as abruptly as they start and rarely last more than a few days.  When they do occur I think back to all the things I did in 2006 to shut down those overly excited heart cells.  I unplug from work, take some time for me, cut back on the caffeine and chocolate (oh yeah, did I forget to mention?  I eat chocolate and drink soda again!), and within 3-36 hours my heart has mellowed out, thumping along happily.

I wish I could tell you there was a magic bullet for these PVCs, but for most of us I don’t think there is.  I don’t think there’s a point where you can be certain you’ll never have another palpitation, no matter what you do to prevent it.

For many of us I think stress is the primary cause, and chronic stress can make your powerful brain do some strange things to the rest of your body.  And the worst thing about stress is there’s no outward, telltale sign.  Your fingers don’t turn blue and you don’t break out in hives.  And for me, stress doesn’t fall like a bag of bricks.  It’s a slow river, it’s acidic waters slowly etching away at the insulation of my nerves, changing me so slightly from day to day as to not notice any change at all, until suddenly a bit of the raw nerve is exposed and my heart starts tripping and skipping.  But if I can back away from those things that may be making me anxious and just let go of some of my worries, my heart settles right back down.

I hope an idea or two here can help you, too.

*I keep a running excel spreadsheet with notations to track my arrhythmias, so that I can look for trends in either time of year or circumstances, so that I can limit my exposure to those things that are likely to cause me too much stress and consequently too many PVCs.