my sister diagnosed with AF. Not many events so far and is on Apixaban and bisoprolol 2.5mg. She tolerates this well but has recently been prescribed steroids for chronic pain. She has noticed an increase in heart rate and has had two episodes of AF this week which is unusual for her. Do you think the steroids are related or just coincidence. Is starting to worry which is not helping.
Any advice: experience of this?
Thanks in advance.
I think the link between steroids as well as NSAIDs and AF is well known . I think it best to discuss with her doctor what his thinking was and what alternatives there may be. Most of us with AF and chronic arthritis are limited to paracetamol and codeine
ThNks Bob. I didn’t realise steroids were considered NSAIDs. I will let her know .
I go into afib on NSAIDS and used to be prescribed high doses for TMJ. Several Dr's and dentists said it wasn't possible and just tht I was wanting narcotics 🙄. They also cause horrible swelling in my ankles and hands. Muscle relaxers also put me in afib. I have taken steroids a few times for severe allergies but a couple of Dr's have been leary to give them to me bc of my afib. I have had some palpitations on them but never afib. I would guess if I had to take them long term for something they would cause me afib as well.
Dear Fishingqueen,
I’m a fellow TMJ sufferer. Aspirin + caffeine was my go-to (along with a migraine med when necessary), but sspirin was no longer possible with anticoagulants. Acetaminophen barely took the edge off. I was suffering TMJ pain daily for months, an exceptionally long episode. Talk about something that ruins one’s QOL.
Why I’m writing is to say that my TMJ has disappeared 97% after just two craniosacral treatments (by a certified practitioner). I’m practically giddy with relief. I'm utterly astounded. This is after years of pursuing a solution to TMJ.
For those of you without TMJ but who have had a leg cramp, TMJ is like having a leg cramp in your jaw. And one that won’t go away. It hurts like hell when it flares.
Try a craniosacral therapist? I’m just passing on my experience.
Yes, it's a side effect that many patients on steroids have had occur especially when they first start on higher doses.Even generally healthy people have been known to have the odd episodes of acute steroids induced aFib or tachycardia when they first start steroids when the doses are higher.
It's because steroids help pain by affecting your cortisol levels , sort of keeping your "Fight and Flight" response at a higher gear to help speed up the bodies response to inflammation. Of course , that gives you a higher heart rate as well , even if you don't have aFib, but that change in heart rate can be a trigger.
Your sister needs to contact the GP immediately.
She needs to request to speak to a GP on the phone sometimes tomorrow mentioning the fact that her steroids are triggering her aFib and she needs some urgent advice to stop that.
If there are other pain relief options other than steroids it's often better to try that , especially if your sister has only just begun steroids.
But there are some conditions , like PMR or GCA, that only responds to steroids.
In those circumstances your sisters GP should make a short term alteration to your sister's aFib rate control medication , making the dose a little higher whilst she becomes used to the steroids therapy or reduces to lower doses.
It can also help to stagger her medications , by taking her beta blockers or other rate medication 1-2 hours before the steroids to help reduce the risk of a heart rate spike.
Some people find they need to take the steroid in the evening as a gastric resistant pill with a PPI, rather than the morning, because the heart rate is naturally lower in sleep, but if this is the evening option is what the GP suggests your sister will have to ask if she got prescribed a gastric resistant pill in the first place, and if not request a new prescription for the gastric resistant type with a PPI if she isn't already using one because steroids and NSAIDs can cause stomach issues.
The third option is a split dose , half in the morning and half at night if the dose is high ( over 9mg) . The night time dose again needs to be the gastric resistant type and taken a couple of hours before bed. Splitting the dose still fights the inflammation but doesn't cause the palpitations that are common on steroids doses of 10mg or more. This can be a better alternative for people with aFib whom need to take steroids long term.
If it still keeps happening regularly despite changes, even if steroids are the best option, you sister would need to speak to the GP again because in that situation the risk of the steroids would be higher than the benefit , and another antiinflammatory option or " steroids sparer" would need to be tried even if it may not be as effective.
Hope she feels better soon, take care, Bee
really appreciate advice and replies. Her GO is her friend/ ex employer here in rural Ireland !!
GP
I am given steroid sparing drugs as steroids are known to be contraindicated for arrhythmias. Trouble with specialities is that there is often no conferring. My cardiologist and neurologist always checked with each other because there is a lot of meds which are contraindicated for one or other condition.
It’s not a good idea to just stop steroids but I imagine she is just tapering up so maybe ring GP for immediate advice and don’t take no for an answer! I am assuming Prednisone?
I only know that she was started on the steroids recently and is finding them very helpful but doctor reducing them graduallly. I will talk to her tomorrow in more detail and come back here for advice/input. Really useful so thanks so much.
i had a strong steroid cream on my neck for a rash for 10 days and went into AF the cardiologist said it was quite possible
I would think it is the steroids that have caused this, but , in the end, her needs and safety will have been weighed up carefully by her doctor and the best course of treatment given. As Bob says, I think she ought to have a conversation about this with her GP, just for reassurance.
Steve
I do hope you are right. I will let her know about all your replies
I’ve no doubt so. There is good evidence that steroids can improve AF, indeed. Doctors follow strict guidelines and use their best judgment given the individual patients case history. Of course, mistakes can happen but these days with computerised records they are unlikely as the system would likely have flagged up anything that is a caution or contraindication.
For the vast majority of people the risk from AF is of a blood clot forming in the atria and your sister is protected from this with apixaban.
If you search the internet for a WebMD article on using steroids to treat AF on the internet, you’ll be relieved by what you read. It’s called “Atrial Fibrillation and Inflammation”.
Here’s a quotation from it: “Since they’re known to lower inflammation, some researchers think steroids could help prevent and treat AFib. One study found that the steroid drug methylprednisolone could help stop AFib from happening again.”
Steve
I was on steroids for Polymyalgia and my EP wanted me off them, he said they can interfere with the heart rate and medication to control heart rate. I was on a low dose but still took me another year or two to finally get off them. I did have awful episodes of afib but have recently had an Ablation so will see.
Thanks for that. Useful to know.
I avoid steroids. I had a Dr give me some oral steroids for a sinus issue and had a bad epidode of AFIB. I talked with my electro physiologist about this and got a strong maybe. I avoid them.
I can't tolerate steroids by any means. I can't take it in nasal form anymore (Flonase) for allergies as it would set off an episode. Nearly two years ago, after a very bad allergy season, my GP prescribed a steroid injection and also an inhalant. I suffered the worst a-fib episode to date, ending up in the ER, and necessitating an ablation (my 3rd) three months later. Steroids aren't for me!
thank you
I take 2.5mg-5mg prednisone daily to keep PMR at bay. If PMR raises its ugly head anyway, at the first sign I up the dosage (all this with my PCP’s guidance) to 10mg-15mg to stop the PMR before it can grab hold. Then back to low dosage in a day or two.
I’ve never connected my steroid use with my AF episodes, though who knows, complicated creatures that we are.
I’ve read studies that support the use of steroids to reduce inflammation post-ablation. I’ve read other studies that say there is no effect, and still others that say there is a negative effect. My conclusion is that nobody really knows and that reactions to steroids are simply different in different people. All of us have to find what works for us, not for a statistical percentage in a cohort of people in a study.
I take prednisone. I’m in NSR after two ablations. I feel good. That’s my experience.
Hi Sweetmelody. Completely agree. Numerous contradictory research out there.
Yes. I took prednisone for lupus for 15 years years and developed AFib a few years ago. I was given 1 mg tabs of prednisone, and my doctor told me to see how I felt on different doses. The higher doses definitely destabilized my heart. I am currently taking 1 mg a day, which is a very low dose and, along with weight loss and exercise and getting off large doses of other meds, I have no more aFib for maybe a year, knock on wood.
Also, for the pain, I took a lot of ibuprofen and tylenol and aspirin and occasional hydrocortisone, and tried to train my mind that pain was just a feeling, don't over-react to it, be neutral towards is. Then I developed kidney failure from high bp and too much iburprofen and that's the point where I summoned the will power to go on a strictly kidney friendly diet which has also cleared away my other chronic problems, such as afib.
I sent this thread to my sister and she is very impressed by the variety of replies - and the generosity of you all in sharing your knowledge and experience.
Thanks again
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