The Missed Stair
You are sitting still. Feet up, nothing happening.
Your heart does a stumble. A thud, then a gap, then a bigger thud, like missing a step on a staircase you have walked a thousand times.
You put your hand flat on your chest and wait.
It happens again at eleven, lying on your left side, in the dark.
The ECG was normal. Somebody said the word stress and moved on.
Nobody explained the thud to you. So here it is.
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Don’t wait:
Your Heart Rate Is Not Set By Your Heart
Your heart has its own electrical pacemaker, but the tempo is negotiated by your autonomic nervous system. Sympathetic pushes it up, parasympathetic holds it down.
Estrogen influences that balance, and there are estrogen receptors in cardiac tissue and in the vessels feeding it.
When estrogen swings hard in perimenopause, the sympathetic side gets the upper hand more often. The threshold for an extra beat drops.
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What You Are Actually Feeling
The sensation is almost never a skipped beat. It is an extra one.
An early beat fires before the chamber has finished filling, so it moves almost no blood and you feel nothing.
Then comes a pause while the electrical system resets. During that pause the ventricle keeps filling.
The next beat empties a fuller chamber, harder than usual.
That is the thud. You are not feeling your heart stop. You are feeling it catch up.
Half Of Women
SWAN tracked palpitations in 3,276 midlife women and published in the journal Menopause in 2023.
They found three patterns. Just under 16 percent of women had a high probability of palpitations. Another 34 percent had a moderate probability.
Half of all women. Elevated through perimenopause and into early postmenopause, then falling away.
And here is the part worth holding onto. In the subgroup with vascular imaging, palpitation patterns showed no relationship to atherosclerosis or arterial stiffness.
Get It Documented, Once
Do this properly one time. A twelve second ECG in a room where nothing is happening proves nothing.
Ask for a Holter monitor or a two week patch. Keep a paper log while you wear it. Time, what you were doing, what it felt like.
You want your ordinary flutter captured on a rhythm strip, with a note beside it, in your file. Then it is a documented fact rather than a description a stranger gets to weigh.
Some Things Do Not Wait For A Monitor
Fainting or nearly fainting. Chest pain. Breathlessness while resting. A fast regular racing that switches on and off like a light. Sudden cardiac death in your family.
Any of those and you go now, not in three weeks.
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Then Take Back The Triggers
Alcohol in the evening. The four o'clock coffee. The five hour night.
Each one raises sympathetic tone, and each one is yours to move.
And when it starts, lengthen the exhale. Longer out than in, about six breaths a minute, two minutes. That is a direct line to the parasympathetic brake.
You did not become anxious. You started hearing the machinery.
