Prednisone and cardiac symptoms

Hi @prestol, I haven't experienced any cardiac related symptoms while I was on prednisone for my two occurrences of PMR. While you wait for members with experience to respond, here are the discussions and comments from members who have posted about cardiac symptoms and prednisone - https://connect.mayoclinic.org/search/?search=Prednisone%20and%20cardiac%20symptoms.

When is your echocardiogram and cardiology consult scheduled?

Prednisone has far reaching effects on your heart.
https://www.verywellhealth.com/prednisone-heart-rate-5113682#:~:text=Prednisone%20is%20a%20steroid%20drug,irregular%20heartbeats)%2C%20and%20palpitations.
I don't wish to alarm people but don't let anyone tell you that prednisone side effects are easy to manage if you know how. The problem with cardiac side effects from prednisone is they are usually "silent." You don't really know what your heart is doing most of the time.

People sometimes feel a racing heart but that can be attributed to exercise, stress, or simply getting excited about something. It is good that your smart watch is monitoring your heart rate for you. Calculating your average daily heart rate is good because your heart rate changes all the time.

My "normal" resting heart rate was below 60 but I never had a smart watch back then. By most standards ... below 60 would be called bradycardia. On prednisone, my resting heart rate was in the 70's which is considered normal. Nothing to worry about except a resting heart rate in the 70's wasn't normal for me.

I won't go into all my cardiac problems that I developed while on Prednisone. I didn't have many symptoms because I was mostly "symptom free." My very first symptom was "exercise intolerance" but that is subjective. I complained about not tolerating exercise but tests said I had a "normal exercise tolerance."

The culmination was when I noticed my pulse was irregular along with being short of breath ... not to mention being absolutely exhausted. This all happened while doing something that shouldn't have been so exhausting. I told my primary care doctor who wanted to do an EKG.

The EKG detected left ventricular hypertrophy (LVH) which is usually caused by high blood pressure except my blood pressure. I never felt my blood pressure and it was always normal whenever it was checked. Similar to catching a cardiac arrhythmia, which people also don't feel most of the time, I was instructed to check my blood pressure more often.

My blood pressure was "normal" until I caught a blood pressure reading that exceeded 210/110 for no apparent reason. That got my attention and my blood pressure was verified in the emergency room. I didn't feel anything but I soon had a cardiology consult. The cardiologist started three blood pressure medications. The cardiologist said my heart was being "stretched" and was getting "irritable." I had no idea that was happening.

My problem was the erratic nature of my heart rate and blood pressure when I was on prednisone. I never felt anything. It was like my body had lost control of how to regulate those things.

I'm off Prednisone now. My blood pressure medications were stopped one by one. Things aren't so erratic anymore.

Thanks, John, for the links. Both appointments are scheduled about a month from now. I am out of town for the next few weeks on a long-scheduled winter getaway, which I almost cancelled but am now glad I didn’t. Our mental health is important too! I am trying hard to adhere to a low-salt/high potassium diet to deal with the fluid retention, which also seems to be improving. I had labs to check my electrolytes just before leaving, and all were in the normal range, except that potassium was at the very low end of normal. I took furosemide for 5 days, and can restart it if needed. I’m not always sure when to contact my pcp (who has ordered all this) and when my rheumatologist.

@dadcue, what a scary experience. I am so glad you have now found a good alternative to prednisone. So far I have not had shortness of breath, exhaustion, erratic pulse, and would seek care away from home if necessary.

I took prednisone in higher doses for a long time - 12 years.

Taking a high dose for a long time had a lot to do with my cardiac problems. I was oblivious to my cardiac problem most of the time because I was mostly asymptomatic. The exercise intolerance was very subtle but I could tell something was different. It was my brother who told me something was seriously wrong with me when I was lagging behind him and couldn't keep up.

I listened to my body but sometimes it wasn't saying there was anything wrong. People tend to want to be "pain free" but it is precisely pain and discomfort that tries to tell us something might be wrong.

Your 40 mg dose is a high dose. That was the same dose I started with. Sometimes I needed a bit more to stay relatively pain free.

I hope you are able to reduce your dose relatively quickly That wasn't possible for me because I was focused more on pain rather than some of the other more subtle signs and symptoms that occurred.

My cardiac problems didn't happen suddenly in my first year. I think my cardiac problems happened slowly over time and became more apparent sometime well into my second year. My prednisone dose was still more than 30 mg after 2 years. I didn't get much below 20 mg for 10 years.

Yes, I'm on prednisolone and have heart issues (heart attack 8yrs ago and now regurgitating valves, not too serious), so I monitor and record blood pressure/heart rate every day. On the odd occasion that my heart rate drops to 40-42, usually accompanied by nausea, a strong heart beat or palpitations, I'm reminded to drink more water. Within an hour or so of drinking two large glasses the heart rate is always increased. Even before being on prednisolone, it would happen occasionally and was always to do with not drinking enough water.

Furosemide: I was taking this occasionally to reduce fluid till a year ago. It messed with my electrolytes and caused lower back pain (kidneys) when taken for more than a week so I am now instructed not to take it at all. To keep fluid retention under control and to protect the kidneys by giving them a good flush, I now drink extra water instead and eat low carbohydrate. I've had no fluid retention problems while on prednisolone.

@megz, I will try increasing my water intake when I first get up. Being dehydrated after a long night may very well be the issue causing the 40-42 BPM early in the morning. Usually that’s the only time it drops so low. Thanks for your helpful contribution.

Autoimmune inflammation in rheumatic disease
has been associated with vagal autonomic neuropathy.
Heart rate variability and response to standing and
other parameters are often abnormal when studied.
Some cardiac symptoms may be subclinical for a time
before we feel the symptoms.
Our cardiac event risks are heightened with most
types of systemic inflammation and should be monitored for primary preventative measures.
Primary care physicians and specialists need to
be aware of our need for screening.