Irregular heartbeat issues

@pmrsuzie
Agreed! My cardiac electrophysiologist put me on verapamil for PACs. I'm also on sotalol for PVCs prescribed by my regular cardiologist in the same office. Both lower BP so I was told to lower my BP meds. I'm on a very low dose of BP meds now. This is the first time I've heard of a rheumatologist making a decision on a cardiac Rx.

@jabrown0407
It all worked out fine. Since then I’m taking it monthly and hopefully will be off everything soon. My labs were fine through it all.

@pmrsuzie I took it for decades for migraines before a parathyroidectomy miraculously cured them, which is why my PCP prescribed them for me again when she was unable to get a good blood pressure read due to my anxiety. She reasoned that I could tolerate them, and frankly, she felt that she was protected in case my anxiety masked essential hypertension. People who don’t suffer from it have no idea what it can do. We were working on the anxiety component and had plans to cut my dose further but retired, and I barely had time to establish a relationship with her replacement when she, too, left the practice. So I was still on a therapeutic dose for hypertension when I was hit with the hypotension characteristic of prednisone withdrawal/SAI. When I almost collapsed a few weeks ago, I immediately recognized what was going on because I had seen my husband have the same reaction to a different drug. My required training in epidemiology as a core area in public health gave me a different more analytical way of looking at disease from the often algorithmic approach of medicine, particularly taking into account exposures in the environment. I am confident that my rheumatologist’s diagnosis is correct, although I am saddened that he missed the initial signs of prednisone withdrawal way back in the early spring before my inflammation levels rose higher than they had been when I was first diagnosed with PMR several years ago. Eventually I will go back on Verapamil, but for the moment, to use an analogy, it was like pouring oil on a fire. The trick is to listen to my body.

I've had runs of PVCs all my life (now 81) and had ablations for these and for tachycardia episodes a few years ago. These seemed to almost eliminate these unpleasant episodes. Before the ablations, I had been tried on Flecainide which didn't work for me.
On starting with predisolone for PMR, 3 months back I noticed some recurrence of PVCs at times. Tiredness, stress, indigestion, disturbance of vagus nerve tone? You notice them once you become sensitised to the feeling of being a bit 'off'.
Most people have the odd one and are unaware.
Another factor can low pulse rate and low blood pressure on starting steroids or adjusting dose.
If pulse is slow 50-60 bpm, the odd ectopic beat (PVC) becomes more noticeable. One cardiologist told me he also gets them and walks / runs up the stairs to raise his pulse rate..

It’s worth remembering PMR is a cortisol issued/an endocrine issue and the steroids, and therefore the tapering, can affect other parts of the endocrine system. I have Graves Disease (overactive thyroid) and there’s quite a lot of literature about how carefully one needs to taper for PMR to avoid things like palpitations, raised heartbeat, sleep disturbance, feeling hot and bothered etc. because the thyroid gland is also effected by the steroids and therefore by the taper. I go down 1mg a month (from 15mg) and have a few early days of ‘flutters’, overheating, insomnia, general ‘buzziness’ until I settle into the new dose. The recommendation for Graves Disease is to drop 1mg or 0.5 mg a month until into single digits and even then to stick at 1mg drop per month down to 0. The adrenal gland is working hard to adjust during tapering but so are the others - pituatry, hypothalamus, thyroid etc. which are also affected by taking the steroids for PMR. Have a look at search terms HPA Axis - Thyroid - PMR - steroids.

Well, I am between PCPs and the nurse in my former one's office sure as h*** didn't know anything. It turns out that the verapamil was the problem -- the effect of lowering BP when I was already experiencing hypotension pushed my BP too low, and my heart was trying to compensate. No more verapamil, no more extremely high heart rate. No more feeling like I am going to collapse. I took it mainly as an a** cover on the part of my retired PCP because my anxiety can break through any measurement. It pays to understand epidemiology and how exposures affect health outcomes. So I really don't want to discuss this anymore.

The heart monitor will let you know how many PAC’s you are having in a 24 hour time frame and if it is acceptable. If your pulse runs a bit high you can slow it down just a bit, that eliminated most of mine. Also, have your thyroid checked. Blood work, T4/TSH. That was also giving me PAC’s. By the way, AFib and PAC’s are not the same thing.

@fredinwoking
Hi,
Thank you for your post on heart rate and PVC's. One thing you said was "disturbance of vagus nerve tone. Could you say more about that.
Thank you! X

First point - I am not a medical practitioner but a (semi-retired) chemical engineer - so pls take the following with a pinch of salt.
The vagus nerve links the brain with pretty much all organs including the heart rhythm.
SVT (tachycardia) episodes which I had occasionally in my youth and again after age 60 can often be arrested by Valsalva manoever / modified Valsalva or carotid artery massage which temporarily raise blood pressure and presumably stimulate the vagus nerve. Carotid massage must be done with care - pls research before trying.

A cardiologist once told me that PVCs (ectopic beats) were related to the Vagus nerve 'tone'.

Coincidentally (?) I have found long ago that after a meal that causes a bit of wind (burp tendency) I am more prone to PVCs. I assume this slight increase in gastric pressure is picked up by the vagus nerve and interferes with its smooth function.
I had a cardio ablation a few years ago which zapped the SVT source in the heart muscle and also reduced the PVCs.
Why I seem to get more PVCs since on prednisolone may be because - as we know - the drug suppresses the normal production of cortisol by the adrenal glands. The complex interplay and normal balance between the Vagus nerve and the hormone systems eg HPA axis can therefore be upset somewhat. My conclusion is just to put up with the PVCs and gradually get off Pred as soon as I safely can. If I have a run of PVCs which is annoying and unpleasant, my first actions are try to get rid of any stomach wind, do some 'box breathing' and / or gentle carotid pressure.

I will look into vagus nerve stimulation. I’m probably leaving the integrative medicine center where I have been receiving care, though, now that my PCP has retired. I live in a continuing care retirement community, and we have on-site geriatricians. They are schooled in more traditional medicine, though, and I don’t know how open the one I have signed up to see here will be to non-traditional medicine. Around here, if you are older and the word “heart” is mentioned, you are automatically assumed to be having a heart attack . I suffer extreme anxiety and wound up in the ER a few years ago for a “heart attack” which was actually anxiety so after about 7-8 hours in the ER during which I was not allowed any food or drink, I was told there was nothing wrong, goodbye. Recently my SAI related hypotension combined with my medicine for white coat hypertension caused a couple of fast heartbeat with wanting to faint episodes and yep, again, the triage nurse said I was having cardiac problems. The EMTs found nothing wrong. My pharmacist helped me cut down and then cut out the hypertension meds and the literal sinking feeling has stopped.