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Dr. Sarrel describes how a woman's hormones and heart work together and why some women experience tachycardia, a rapid heart-rate.
Dr. Sarrel:
The issue of rapid heart-rate in women is a very interesting one, and the reason is, so far what I have been talking about is how a woman’s hormones can help open blood vessels and keep enough oxygen going to prevent damage to the muscle in her heart. But there’s another set of actions that her hormones have and that has to do with how a signal is sent across the heart. Remember that there’s an electrical signal that makes the heart muscle contract and then relax, and then contract and then relax.
And there is a condition that’s not a rare condition, which is called tachycardia and that’s a condition in which the heart rate is very, very fast. Normally we think of the heart rate as somewhere between 50 and 90 – something like that or 50 and 80. And somebody with tachycardia the heart is speeding along at 150 or 200 beats-a-minute. It’s a very, very uncomfortable feeling and what goes along with it also is it’s a very scary feeling. So it’s not unusual for somebody in the midst of a tachycardia to think, “I think I am going to die.” I mean, it can be that significant a feeling in their chest.
Well, people who study electrophysiology, the transmission of that signal, have also studied how hormones affect it and one of the actions of a woman’s estrogen, and the estrogen we are talking about in her body is called estradiol, one of the actions of estradiol is to protect nerve transmission of the signal.
One of my patients who lives in another part of the world now and she herself is a research scientist, she is a Ph.D, she gave me permission to submit her history to the EmpowHER website so other women would know her story.
She is a woman who in her mid 40s had a hysterectomy and lost the function of her ovaries and soon after that developed tachycardia and no one could figure out what was going on and at that time she was working at Yale and I saw her as a patient and I started her on estradiol in the form of a skin patch and within a few days her tachycardia stopped.
So it wasn’t her thyroid gland that was causing the tachycardia, that’s often the case, and it wasn’t some problem in her heart. It had to do with the action of the hormone in controlling the transmission of the signal across the heart. She is now more than ten years into that and gradually as she has gotten older we have lowered the dose. One of the beauties of using the patch estradiol is there’s a lot of different doses and you can tailor it to each woman.
And this woman very clearly describes, if we go below a certain level, the tachycardia is back within 24 hours. Bring it up by a tiny amount; the tachycardia stops. So it’s just another illustration.
There’s another very interesting condition that’s been described by cardiologists and most recently a condition related to the estradiol level. It’s a condition best studied in Japan and that’s called tako-tsubo disease. Tako-tsubo is the Japanese word for octopus and it’s a condition in which the patient says, “I am getting this pressure in my chest,” and when they do a picture of it, when the cardiologist, radiologist gets an image of the heart, the image is like an octopus is squeezing the heart muscle – very frightening.
It affects how much blood flow the heart can pump out and what the Japanese have shown very clearly is it’s due to a deficiency of estradiol and if you replace the estradiol, you stop the syndrome. Isn’t that interesting? So it’s not just blockage of an artery, the classical atherosclerosis that we all are concerned about. There are other conditions like the tachycardia, like the tako-tsubo.
In fact, women will have, like the young woman I have talked about earlier, the 34 year old who died when her daughter was arrested for shoplifting, she had normal arteries but she didn’t have enough of a dilating effect and that could kill a woman too. So there are these things to think about that are different in women from men.
About Dr. Sarrel, M.D.:
Philip M. Sarrel, M.D., completed his medical education at New York University School of Medicine, his internship at the Mount Sinai Hospital, and his residency at Yale New Haven Hospital. In addition to his many years on the faculty of the Departments of Obstetrics and Gynecology and Psychiatry at Yale University School of Medicine, Dr. Sarrel has also been a Faculty Scholar in the department of psychiatry at Oxford University, Visiting Senior Lecturer at King’s College Hospital Medical School at the University of London, Visiting Professor in Cardiac Medicine at the National Heart and Lung Institute in London, and Visiting Professor in the Department of Medicine at Columbia University College of Physicians and Surgeons in New York. He is currently Emeritus Professor of obstetrics, gynecology, and psychiatry at Yale University.
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